Provider Demographics
NPI:1245836287
Name:STANDARD RESIDENTIAL CARE LLC
Entity type:Organization
Organization Name:STANDARD RESIDENTIAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BEBYTHO
Authorized Official - Middle Name:
Authorized Official - Last Name:TIMOTHE
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:862-684-0895
Mailing Address - Street 1:92 BURNETT AVE APT 306
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-2984
Mailing Address - Country:US
Mailing Address - Phone:862-684-0895
Mailing Address - Fax:
Practice Address - Street 1:92 BURNETT AVE APT 306
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-2984
Practice Address - Country:US
Practice Address - Phone:862-684-0895
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Multi-Specialty