Provider Demographics
NPI:1598958340
Name:LIVING NEW, REAL FAMILIES INC.
Entity Type:Organization
Organization Name:LIVING NEW, REAL FAMILIES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TYSHAMMIE
Authorized Official - Middle Name:COOPER
Authorized Official - Last Name:DELISLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-509-7600
Mailing Address - Street 1:356 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3646
Mailing Address - Country:US
Mailing Address - Phone:973-509-7600
Mailing Address - Fax:
Practice Address - Street 1:15 SOUTH 9TH STREET
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102
Practice Address - Country:US
Practice Address - Phone:973-497-9300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0125059Medicaid