Organization · NPI-2

Broadway Group Home LLC

Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities · North Brunswick, NJ

NPI number1790481646
StatusActive
Last updated in NPPESFeb 2, 2023

Details

NPI
1790481646
Entity type
Organization (NPI-2)
Legal business name
Broadway Group Home LLC
Organization subpart
No
Enumeration date
Feb 2, 2023
Certification date
Jan 27, 2023
Last updated
Feb 2, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities––Yes

Practice location

1364 Sioux Rd
North Brunswick, NJ 08902-1522

Phone 973-546-0488

Mailing address

17-17 Broadway
Fair Lawn, NJ 07410-2055

Phone 201-703-3980

Authorized official

Patrick Patton
Coo
9735460488

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