Provider Demographics
NPI:1356012645
Name:MINOS WORK PROGRAM LLC
Entity Type:Organization
Organization Name:MINOS WORK PROGRAM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:MINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:862-251-1672
Mailing Address - Street 1:16 OAK PL
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3825
Mailing Address - Country:US
Mailing Address - Phone:862-251-1672
Mailing Address - Fax:
Practice Address - Street 1:16 OAK PL
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3825
Practice Address - Country:US
Practice Address - Phone:862-251-1672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-26
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Multi-Specialty