Provider Demographics
NPI:1851090583
Name:BEACON SPECIALIZED LIVING NEW JERSEY, INC.
Entity Type:Organization
Organization Name:BEACON SPECIALIZED LIVING NEW JERSEY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-427-8400
Mailing Address - Street 1:13 ROSZEL RD STE B110
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-6211
Mailing Address - Country:US
Mailing Address - Phone:609-987-5003
Mailing Address - Fax:609-520-7979
Practice Address - Street 1:370 SULLIVAN WAY
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08628-3411
Practice Address - Country:US
Practice Address - Phone:609-987-5003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0450858187Medicaid