Provider Demographics
NPI:1841766813
Name:JEFFRIE POPPLEWELL LLC
Entity Type:Organization
Organization Name:JEFFRIE POPPLEWELL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFFRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:POPPLEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPT, LCADC,
Authorized Official - Phone:201-886-9531
Mailing Address - Street 1:770 ANDERSON AVE APT 14K
Mailing Address - Street 2:
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-2183
Mailing Address - Country:US
Mailing Address - Phone:201-957-3497
Mailing Address - Fax:201-886-9531
Practice Address - Street 1:770 ANDERSON AVE APT 14K
Practice Address - Street 2:
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010-2183
Practice Address - Country:US
Practice Address - Phone:201-957-3497
Practice Address - Fax:201-886-9531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility