Provider Demographics
NPI:1225924129
Name:WJ ADULT SERVICES LLC
Entity type:Organization
Organization Name:WJ ADULT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LA ROSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-817-2954
Mailing Address - Street 1:248 LAKE AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-5469
Mailing Address - Country:US
Mailing Address - Phone:603-932-2973
Mailing Address - Fax:
Practice Address - Street 1:248 LAKE AVE APT 2
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-5469
Practice Address - Country:US
Practice Address - Phone:603-932-2973
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities