Provider Demographics
NPI:1780740522
Name:ADVANCE HOUSING, INC.
Entity type:Organization
Organization Name:ADVANCE HOUSING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:JAIME
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:201-498-9140
Mailing Address - Street 1:100 HOLLISTER RD
Mailing Address - Street 2:
Mailing Address - City:TETERBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07608-1148
Mailing Address - Country:US
Mailing Address - Phone:201-498-9140
Mailing Address - Fax:201-498-9144
Practice Address - Street 1:100 HOLLISTER RD UNIT 7
Practice Address - Street 2:
Practice Address - City:TETERBORO
Practice Address - State:NJ
Practice Address - Zip Code:07608-1139
Practice Address - Country:US
Practice Address - Phone:201-498-9140
Practice Address - Fax:201-498-9144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7854102Medicaid