Provider Demographics
NPI:1457871436
Name:SPECIAL PARENT ADVOCACY GROUP A NJ NON PROFIT CORPORATION
Entity type:Organization
Organization Name:SPECIAL PARENT ADVOCACY GROUP A NJ NON PROFIT CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WHITFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-203-5995
Mailing Address - Street 1:20 SCOTCH RD STE E
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08628-2529
Mailing Address - Country:US
Mailing Address - Phone:609-203-5995
Mailing Address - Fax:609-642-2398
Practice Address - Street 1:129 BULL RUN RD
Practice Address - Street 2:
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-5303
Practice Address - Country:US
Practice Address - Phone:609-203-5995
Practice Address - Fax:609-642-2398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-21
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2050XRespite Care FacilityRespite CareRespite Care Camp
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========Medicaid