31D2235590 CLIA NUMBER - SPECIAL NEEDS RESIDENCE LLC DBA MT BETHEL VILLAGE

Laboratory Demographics

CLIA Number: 31D2235590

Facility Name: SPECIAL NEEDS RESIDENCE LLC DBA MT BETHEL VILLAGE

Facility Address:
130 MT BETHEL ROAD
WARREN, NJ
ZIP 07059
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Facility Phone Number: 908 757-7000

Facility Type: Intermediate Care Facility for Mentally Retarded

Certificate Type: Waiver

NPI Number: 1811553217

Taxonomy: 320900000X - Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities.

CLIA Record

Field Name	Field Value
CLIA Number	31D2235590
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	SPECIAL NEEDS RESIDENCE LLC DBA MT BETHEL VILLAGE
Street	130 MT BETHEL ROAD
City	WARREN
State	NJ
ZIP	07059
Phone	908 757-7000
CertificateType	4
CertificateEffectiveDate	9/10/2023
CertificateExpirationDate	9/9/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024