Provider Demographics
NPI:1811358666
Name:PRIDE DAY PROGRAM ECLC OF NJ
Entity type:Organization
Organization Name:PRIDE DAY PROGRAM ECLC OF NJ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DOROTHEA
Authorized Official - Middle Name:S
Authorized Official - Last Name:LIBMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-665-4558
Mailing Address - Street 1:100 PASSAIC AVE
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:403 SETTE DR
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2912
Practice Address - Country:US
Practice Address - Phone:201-265-1040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services