Broadway Group Home LLC
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities in North Brunswick, NJ. Organization (NPI-2).
NPI number1861106478
StatusActive
Last updated in NPPESMar 5, 2024
Details
- NPI
- 1861106478
- Entity type
- Organization (NPI-2)
- Legal business name
- Broadway Group Home LLC
- Organization subpart
- No
- Enumeration date
- Jan 9, 2023
- Certification date
- Mar 5, 2024
- Last updated
- Mar 5, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 320900000X | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | – | – | Yes |
Practice location
1215 Livingston Ave Ste 200North Brunswick, NJ 08902-3834
Phone 201-703-3980 · Fax 201-703-3984
Mailing address
17-17 BroadwayFair Lawn, NJ 07410-2055
Phone 201-703-3980 · Fax 201-703-3984
Authorized official
Jennifer Lozano
Svp Financial Service
7706307290
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