Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
1 | 261QD1600X | Clinic/Center | Developmental Disabilities | | | No |
2 | 305R00000X | Preferred Provider Organization | | | NEW JERSEY | No |
3 | 347C00000X | Private Vehicle | | | | No |
4 | 385H00000X | Respite Care | | | NEW JERSEY | No |
5 | 385HR2055X | Respite Care | Respite Care, Mental Illness, Child | | | No |
6 | 385HR2060X | Respite Care | Respite Care, Intellectual and/or Developmental Disabilities | | | No |
7 | 251B00000X | Case Management | | | NEW JERSEY | No |
8 | 251C00000X | Day Training, Developmentally Disabled Services | | | | No |
9 | 251E00000X | Home Health | | | | No |
10 | 251G00000X | Hospice Care, Community Based | | | | No |
11 | 251K00000X | Public Health or Welfare | | | | No |
12 | 251S00000X | Community/Behavioral Health | | | NEW JERSEY | No |
13 | 251X00000X | Supports Brokerage | | | | No |
14 | 253Z00000X | In Home Supportive Care | | | | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
1 | 0450278949 | MEDICAID | NEW JERSEY | |