Provider Demographics
NPI:1972997310
Name:7TH & MADISON EXTENSIONS LLC
Entity Type:Organization
Organization Name:7TH & MADISON EXTENSIONS LLC
Other - Org Name:7TH & MADISON EXTENSIONS OF EMPOWERMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:T
Authorized Official - Last Name:WEEMS
Authorized Official - Suffix:
Authorized Official - Credentials:BPA
Authorized Official - Phone:800-936-3256
Mailing Address - Street 1:PO BOX 372
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-0372
Mailing Address - Country:US
Mailing Address - Phone:800-936-3256
Mailing Address - Fax:800-936-3256
Practice Address - Street 1:28 VALLEY RD STE 1
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2709
Practice Address - Country:US
Practice Address - Phone:800-936-3256
Practice Address - Fax:877-413-9752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-24
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251C00000X, 251X00000X, 261QD1600X, 320900000X, 332B00000X, 332BC3200X
NJ251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
No251X00000XAgenciesSupports Brokerage
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment