Provider Demographics
NPI:1265828396
Name:PRINCE ASSOCIATION FOR THE DEVELOPMENTALLY DISABLED, INC.
Entity Type:Organization
Organization Name:PRINCE ASSOCIATION FOR THE DEVELOPMENTALLY DISABLED, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-877-6745
Mailing Address - Street 1:20 TWISTING LN
Mailing Address - Street 2:
Mailing Address - City:WILLINGBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08046-4116
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:106 N GARDEN BLVD
Practice Address - Street 2:
Practice Address - City:EDGEWATER PARK
Practice Address - State:NJ
Practice Address - Zip Code:08010-2147
Practice Address - Country:US
Practice Address - Phone:609-877-6920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities