Provider Demographics
NPI:1245767987
Name:CLIFTON ADULT OPPORTUNITY CENTER
Entity Type:Organization
Organization Name:CLIFTON ADULT OPPORTUNITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:E
Authorized Official - Last Name:LISBONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-777-7114
Mailing Address - Street 1:900 CLIFTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-2708
Mailing Address - Country:US
Mailing Address - Phone:973-777-7114
Mailing Address - Fax:
Practice Address - Street 1:900 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-2708
Practice Address - Country:US
Practice Address - Phone:973-777-7114
Practice Address - Fax:973-473-6118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No251J00000XAgenciesNursing Care
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1013390459Medicaid
NJ1528442902Medicaid
NJ1063840544Medicaid