Provider Demographics
NPI: | 1508326257 |
---|---|
Name: | SELF CARE ENTERPRISES |
Entity Type: | Organization |
Organization Name: | SELF CARE ENTERPRISES |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER/CEO |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | DANIELLE |
Authorized Official - Middle Name: | D |
Authorized Official - Last Name: | JONES |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 732-527-8398 |
Mailing Address - Street 1: | 180 SCOTLAND RD APT 8 |
Mailing Address - Street 2: | |
Mailing Address - City: | ORANGE |
Mailing Address - State: | NJ |
Mailing Address - Zip Code: | 07050-1443 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 732-527-8398 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 180 SCOTLAND RD APT 8 |
Practice Address - Street 2: | |
Practice Address - City: | ORANGE |
Practice Address - State: | NJ |
Practice Address - Zip Code: | 07050-1443 |
Practice Address - Country: | US |
Practice Address - Phone: | 732-527-8398 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2019-03-20 |
Last Update Date: | 2019-03-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 103TM1800X | Behavioral Health & Social Service Providers | Psychologist | Intellectual & Developmental Disabilities | Group - Single Specialty |
No | 103TH0004X | Behavioral Health & Social Service Providers | Psychologist | Health | Group - Single Specialty |
No | 251C00000X | Agencies | Day Training, Developmentally Disabled Services | ||
No | 253J00000X | Agencies | Foster Care Agency | ||
No | 253Z00000X | Agencies | In Home Supportive Care | ||
No | 261QC1500X | Ambulatory Health Care Facilities | Clinic/Center | Community Health | |
No | 261QD1600X | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities | |
No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | Group - Single Specialty |
No | 320600000X | Residential Treatment Facilities | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | ||
No | 320900000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | Group - Single Specialty | |
No | 373H00000X | Nursing Service Related Providers | Day Training/Habilitation Specialist | Group - Single Specialty | |
No | 385HR2060X | Respite Care Facility | Respite Care | Respite Care, Intellectual and/or Developmental Disabilities, Child | Group - Single Specialty |