Provider Demographics
NPI:1679000921
Name:JEFFERSON PARK MINISTRIES, INC
Entity Type:Organization
Organization Name:JEFFERSON PARK MINISTRIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WOODY
Authorized Official - Middle Name:K
Authorized Official - Last Name:PHILIPPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-469-9508
Mailing Address - Street 1:70 WEST GRAND ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202
Mailing Address - Country:US
Mailing Address - Phone:908-469-9508
Mailing Address - Fax:908-469-9509
Practice Address - Street 1:70 WEST GRAND ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202
Practice Address - Country:US
Practice Address - Phone:908-469-9508
Practice Address - Fax:908-469-9509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-17
Last Update Date:2017-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No347E00000XTransportation ServicesTransportation Broker