Provider Demographics
NPI:1518203462
Name:ST. JOHN OF GOD COMMUNITY SERVICES
Entity Type:Organization
Organization Name:ST. JOHN OF GOD COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:OSORIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-848-4700
Mailing Address - Street 1:1147 DELSEA DRIVE
Mailing Address - Street 2:
Mailing Address - City:WESTVILLE GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:08093
Mailing Address - Country:US
Mailing Address - Phone:856-848-4700
Mailing Address - Fax:
Practice Address - Street 1:1147 DELSEA DRIVE
Practice Address - Street 2:
Practice Address - City:WESTVILLE GROVE
Practice Address - State:NJ
Practice Address - Zip Code:08093
Practice Address - Country:US
Practice Address - Phone:856-848-4700
Practice Address - Fax:856-384-1512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-21
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ251C00000X, 343900000X
261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)