Provider Demographics
NPI:1154781573
Name:NJ THERAPEUTIC CARE OPTION
Entity type:Organization
Organization Name:NJ THERAPEUTIC CARE OPTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:JONES
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:973-820-7190
Mailing Address - Street 1:671 S 14TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-1410
Mailing Address - Country:US
Mailing Address - Phone:973-820-7190
Mailing Address - Fax:
Practice Address - Street 1:671 S 14TH ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-1410
Practice Address - Country:US
Practice Address - Phone:973-820-7190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-26
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
No302F00000XManaged Care OrganizationsExclusive Provider Organization
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No305S00000XManaged Care OrganizationsPoint of Service