Provider Demographics
NPI:1477892701
Name:THE FELICIAN SCHOOL 21 AND OVER PROGRAM
Entity type:Organization
Organization Name:THE FELICIAN SCHOOL 21 AND OVER PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMIGLEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-777-5355
Mailing Address - Street 1:260 SOUTH MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:NJ
Mailing Address - Zip Code:07644-2117
Mailing Address - Country:US
Mailing Address - Phone:862-225-9081
Mailing Address - Fax:973-777-0725
Practice Address - Street 1:460 PASSAIC AVE
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:NJ
Practice Address - Zip Code:07644
Practice Address - Country:US
Practice Address - Phone:862-225-9081
Practice Address - Fax:973-777-0725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-06
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0509965Medicaid