Provider Demographics
NPI:1538679345
Name:EASTERN CHRISTIAN CHILDREN'S RETREAT
Entity Type:Organization
Organization Name:EASTERN CHRISTIAN CHILDREN'S RETREAT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:PRESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-848-8005
Mailing Address - Street 1:700 MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-1047
Mailing Address - Country:US
Mailing Address - Phone:201-848-8005
Mailing Address - Fax:201-847-9619
Practice Address - Street 1:700 MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481-1047
Practice Address - Country:US
Practice Address - Phone:201-848-8005
Practice Address - Fax:201-847-9619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-06
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child