Broadway Group Home LLC
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities in Teaneck, NJ. Organization (NPI-2).
NPI number1619683166
StatusActive
Last updated in NPPESJan 27, 2023
Details
- NPI
- 1619683166
- Entity type
- Organization (NPI-2)
- Legal business name
- Broadway Group Home LLC
- Organization subpart
- No
- Enumeration date
- Jan 27, 2023
- Certification date
- Jan 27, 2023
- Last updated
- Jan 27, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 320900000X | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | – | – | Yes |
Practice location
1231 Longfellow AveTeaneck, NJ 07666-4911
Phone 973-546-0488
Mailing address
17-17 BroadwayFair Lawn, NJ 07410-2055
Phone 201-703-3980
Authorized official
Patrick Patton
Coo
9735460488
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