Provider Demographics
NPI:1740682004
Name:JONES-SWOOPE, SUPERIOR
Entity type:Individual
Prefix:
First Name:SUPERIOR
Middle Name:
Last Name:JONES-SWOOPE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 RUSCOMBE CT
Mailing Address - Street 2:
Mailing Address - City:WILLINGBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08046-4016
Mailing Address - Country:US
Mailing Address - Phone:609-332-6431
Mailing Address - Fax:
Practice Address - Street 1:14 RUSCOMBE CT
Practice Address - Street 2:
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-4016
Practice Address - Country:US
Practice Address - Phone:609-332-6431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ320900000X320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities