Provider Demographics
NPI:1801229703
Name:LEE'S DEVELOPMENTAL SERVICES
Entity Type:Organization
Organization Name:LEE'S DEVELOPMENTAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:YOLANDA
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:RN MSN
Authorized Official - Phone:973-761-0230
Mailing Address - Street 1:50 W SOUTH ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-1730
Mailing Address - Country:US
Mailing Address - Phone:973-761-5306
Mailing Address - Fax:973-378-9525
Practice Address - Street 1:6 MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-1220
Practice Address - Country:US
Practice Address - Phone:973-761-5306
Practice Address - Fax:973-378-9525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-14
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO09927900251E00000X, 252Y00000X, 302R00000X, 310400000X, 385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251E00000XAgenciesHome Health
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child