Provider Demographics
NPI:1992242796
Name:UNLOCKED POTENTIAL, LLC
Entity type:Organization
Organization Name:UNLOCKED POTENTIAL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KEYES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:732-339-3100
Mailing Address - Street 1:331 DORN AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLESEX
Mailing Address - State:NJ
Mailing Address - Zip Code:08846-1117
Mailing Address - Country:US
Mailing Address - Phone:732-339-3100
Mailing Address - Fax:732-601-8715
Practice Address - Street 1:331 DORN AVE
Practice Address - Street 2:
Practice Address - City:MIDDLESEX
Practice Address - State:NJ
Practice Address - Zip Code:08846-1117
Practice Address - Country:US
Practice Address - Phone:732-339-3100
Practice Address - Fax:732-601-8715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1508269911Medicaid