Provider Demographics
NPI:1881981389
Name:WELL OF HOPE COMMUNITY DEVELOPMENT CORPORATION, INC.
Entity type:Organization
Organization Name:WELL OF HOPE COMMUNITY DEVELOPMENT CORPORATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:973-523-0700
Mailing Address - Street 1:207 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07501-2002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:973-523-6462
Practice Address - Street 1:207 BROADWAY
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07501-2002
Practice Address - Country:US
Practice Address - Phone:973-523-0700
Practice Address - Fax:973-523-6462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-05
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)