Provider Demographics
NPI:1013248137
Name:WOMEN'S RISING/PROJECT HOME
Entity Type:Organization
Organization Name:WOMEN'S RISING/PROJECT HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:NEARY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:201-309-4663
Mailing Address - Street 1:657 BERGEN AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-2649
Mailing Address - Country:US
Mailing Address - Phone:201-309-4663
Mailing Address - Fax:201-309-1380
Practice Address - Street 1:657 BERGEN AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-2649
Practice Address - Country:US
Practice Address - Phone:201-309-4663
Practice Address - Fax:201-309-1380
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAYONNE COMMUNITY MENTAL HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-29
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0187275OtherMEDICAID WORK FIRST (SAI)