Provider Demographics
NPI:1447752365
Name:21 PLUS, INC
Entity Type:Organization
Organization Name:21 PLUS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:REGINA
Authorized Official - Last Name:HUTTON-ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-240-3118
Mailing Address - Street 1:1900 ROUTE 70 STE 12
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:08759-4627
Mailing Address - Country:US
Mailing Address - Phone:732-240-3118
Mailing Address - Fax:
Practice Address - Street 1:9 STONEY BRIDGE RD
Practice Address - Street 2:
Practice Address - City:CLEMENTON
Practice Address - State:NJ
Practice Address - Zip Code:08021-2706
Practice Address - Country:US
Practice Address - Phone:732-240-3118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0465721Medicaid