Provider Demographics
NPI: | 1891170189 |
---|---|
Name: | EDEN AUTISM SERVICES |
Entity Type: | Organization |
Organization Name: | EDEN AUTISM SERVICES |
Other - Org Name: | FARLEY HOUSE |
Other - Org Type: | Other Name |
Authorized Official - Title/Position: | MANAGING DIRECTOR ADULT SERVICES |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JAMIE |
Authorized Official - Middle Name: | K |
Authorized Official - Last Name: | DOUGLAS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 609-987-0099 |
Mailing Address - Street 1: | 2 MERWICK ROAD |
Mailing Address - Street 2: | |
Mailing Address - City: | PRINCETON |
Mailing Address - State: | NJ |
Mailing Address - Zip Code: | 08540 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 609-987-0099 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2 LAMBERT LANE |
Practice Address - Street 2: | |
Practice Address - City: | ROBBINSVILLE |
Practice Address - State: | NJ |
Practice Address - Zip Code: | 08691 |
Practice Address - Country: | US |
Practice Address - Phone: | 609-259-1183 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | EDEN AUTISM SERVICES |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2015-07-28 |
Last Update Date: | 2015-07-28 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 320600000X | Residential Treatment Facilities | Residential Treatment Facility, Intellectual and/or Developmental Disabilities |