Provider Demographics
NPI:1023742210
Name:ALL JERSEY SUPPOTED LIVING
Entity type:Organization
Organization Name:ALL JERSEY SUPPOTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PIERRE-JACQUES
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-423-5263
Mailing Address - Street 1:1974 BIRCHWOOD PARK DR N
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-1028
Mailing Address - Country:US
Mailing Address - Phone:609-423-5263
Mailing Address - Fax:
Practice Address - Street 1:1974 BIRCHWOOD PARK DR N
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-1028
Practice Address - Country:US
Practice Address - Phone:609-423-5263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services