Provider Demographics
NPI:1639380579
Name:SLADE ENTERPRISE INC
Entity Type:Organization
Organization Name:SLADE ENTERPRISE INC
Other - Org Name:REHABILITATION SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CORINNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SLADE
Authorized Official - Suffix:
Authorized Official - Credentials:OTR'L
Authorized Official - Phone:201-478-4200
Mailing Address - Street 1:18-01 POLLITT DRIVE
Mailing Address - Street 2:SUITE 1 A
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-2815
Mailing Address - Country:US
Mailing Address - Phone:201-478-4200
Mailing Address - Fax:201-478-4201
Practice Address - Street 1:18-01 POLLITT DRIVE
Practice Address - Street 2:SUITE 1 A
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-2815
Practice Address - Country:US
Practice Address - Phone:201-478-4200
Practice Address - Fax:201-478-4201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities