Provider Demographics
NPI:1972621761
Name:VOLUNTEERS OF AMERICA
Entity Type:Organization
Organization Name:VOLUNTEERS OF AMERICA
Other - Org Name:VOLUNTEERS OF AMERICA-THEODORA HOUSE
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE ASSISTANT CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ORIETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-496-4303
Mailing Address - Street 1:205 W MILTON AVE
Mailing Address - Street 2:
Mailing Address - City:RAHWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07065-3203
Mailing Address - Country:US
Mailing Address - Phone:732-827-2444
Mailing Address - Fax:
Practice Address - Street 1:204 TERRILL RD
Practice Address - Street 2:
Practice Address - City:FANWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07023-1025
Practice Address - Country:US
Practice Address - Phone:732-827-2444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ20001M110440320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6194702Medicaid