Provider Demographics
NPI:1356505150
Name:LIVING NEW INC
Entity Type:Organization
Organization Name:LIVING NEW INC
Other - Org Name:REAL FAMILIES INC
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR/CFO
Authorized Official - Prefix:
Authorized Official - First Name:TYSHAMMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER-DELISLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-497-2471
Mailing Address - Street 1:356 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3646
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:973-497-2475
Practice Address - Street 1:15 S 9TH ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07107-2147
Practice Address - Country:US
Practice Address - Phone:973-497-2471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ20003193-06324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0125059Medicaid