Provider Demographics
NPI:1649889668
Name:OPTIONS IMAGINED A NJ NONPROFIT CORPORATION
Entity type:Organization
Organization Name:OPTIONS IMAGINED A NJ NONPROFIT CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:DESIMONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-583-7490
Mailing Address - Street 1:677 US HIGHWAY 46 STE B
Mailing Address - Street 2:
Mailing Address - City:KENVIL
Mailing Address - State:NJ
Mailing Address - Zip Code:07847-2699
Mailing Address - Country:US
Mailing Address - Phone:973-583-7490
Mailing Address - Fax:
Practice Address - Street 1:2467 STATE ROUTE 10 BLDG 18-1A
Practice Address - Street 2:
Practice Address - City:MORRIS PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07950-1318
Practice Address - Country:US
Practice Address - Phone:973-583-7490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPTIONS IMAGINED A NJ NONPROFIT CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0488267Medicaid