Provider Demographics
NPI:1801362702
Name:THE IN-HOME PARENT COACH, LLC
Entity type:Organization
Organization Name:THE IN-HOME PARENT COACH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SINGLE MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:201-315-4151
Mailing Address - Street 1:151 W PASSAIC ST FL 2
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07662-3105
Mailing Address - Country:US
Mailing Address - Phone:201-315-4151
Mailing Address - Fax:201-300-6109
Practice Address - Street 1:151 W PASSAIC ST FL 2
Practice Address - Street 2:
Practice Address - City:ROCHELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07662-3105
Practice Address - Country:US
Practice Address - Phone:201-315-4151
Practice Address - Fax:201-300-6109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1357674930Medicaid
NJ1861867004Medicaid