Provider Demographics
NPI:1255041497
Name:MADISON'S PLACE INC
Entity type:Organization
Organization Name:MADISON'S PLACE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:AVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:201-213-5658
Mailing Address - Street 1:PO BOX 102
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08818-0102
Mailing Address - Country:US
Mailing Address - Phone:201-213-5658
Mailing Address - Fax:
Practice Address - Street 1:1533 E 2ND ST APT C8
Practice Address - Street 2:
Practice Address - City:SCOTCH PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07076-1638
Practice Address - Country:US
Practice Address - Phone:201-213-5658
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child