Provider Demographics
NPI:1598267171
Name:JW ACTORS STUDIO, LLC
Entity Type:Organization
Organization Name:JW ACTORS STUDIO, LLC
Other - Org Name:SKIT
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JODY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-240-7080
Mailing Address - Street 1:150 CRUSHER RD
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08525-2204
Mailing Address - Country:US
Mailing Address - Phone:609-240-7080
Mailing Address - Fax:
Practice Address - Street 1:487 CHERRY VALLEY RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-7916
Practice Address - Country:US
Practice Address - Phone:609-240-7080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities