Provider Demographics
NPI:1285141911
Name:JERSEY CITY COMMUNITY CHARTER SCHOOL
Entity type:Organization
Organization Name:JERSEY CITY COMMUNITY CHARTER SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SBA
Authorized Official - Prefix:MS
Authorized Official - First Name:NORA
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLEROS
Authorized Official - Suffix:
Authorized Official - Credentials:SBA
Authorized Official - Phone:201-433-2288
Mailing Address - Street 1:128 DANFORTH AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-2626
Mailing Address - Country:US
Mailing Address - Phone:201-433-2288
Mailing Address - Fax:
Practice Address - Street 1:128 DANFORTH AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305-2626
Practice Address - Country:US
Practice Address - Phone:201-433-2288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SW052946001041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Multi-Specialty