Provider Demographics
NPI:1770052540
Name:ASSOCIATES IN MENTAL HEALTH AND DEVELOPMENTAL DISABILITIES, INC
Entity type:Organization
Organization Name:ASSOCIATES IN MENTAL HEALTH AND DEVELOPMENTAL DISABILITIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:K
Authorized Official - Last Name:ADEDOYIN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CSW, CBT, CCSP
Authorized Official - Phone:973-676-8899
Mailing Address - Street 1:60 N WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-1526
Mailing Address - Country:US
Mailing Address - Phone:973-676-8899
Mailing Address - Fax:
Practice Address - Street 1:81 NORTHFIELD AVE STE 106
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-5343
Practice Address - Country:US
Practice Address - Phone:973-676-8899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251X00000XAgenciesSupports Brokerage
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ09645257261532Medicaid