Provider Demographics
NPI:1154871705
Name:JENKINS OUTREACH FOR YOUTH, INC.
Entity type:Organization
Organization Name:JENKINS OUTREACH FOR YOUTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LATESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MS LSW
Authorized Official - Phone:973-698-4172
Mailing Address - Street 1:1407 ELAINE TER
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-4712
Mailing Address - Country:US
Mailing Address - Phone:973-698-4172
Mailing Address - Fax:
Practice Address - Street 1:1407 ELAINE TER
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-4712
Practice Address - Country:US
Practice Address - Phone:973-698-4172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child