# JONATHAN'S HAVEN LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1508494055
- **Authorized official:** MRS. GWENDOLYN MONANGAI BA, LPN, CALA, CDP. (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (973) 652-4541

## Contact information

- **Practice address:** 42 EAGLE ROCK AVE, ROSELAND, NJ 07068-1445
- **Practice address phone:** (973) 652-4541
- **Mailing address:** 42 EAGLE ROCK AVE, ROSELAND, NJ 07068-1445
- **Mailing address phone:** (973) 652-4541

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174200000X | Meals Provider | — | NULL | — |
| 177F00000X | Lodging Provider | — | NULL | — |
| 251B00000X | Case Management Agency | — | NULL | Yes |
| 251C00000X | Developmentally Disabled Services Day Training Agency | — | NULL | — |
| 251J00000X | Nursing Care Agency | — | NULL | — |
| 251S00000X | Community/Behavioral Health Agency | — | NULL | — |
| 3104A0630X | Assisted Living Facility (Behavioral Disturbances) | — | NULL | — |
| 311ZA0620X | Adult Care Home Facility | — | NULL | — |
| 320900000X | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility | — | NULL | — |
| 343800000X | Secured Medical Transport (VAN) | — | NULL | — |
| 385H00000X | Respite Care | — | NULL | — |

## Other

- **Enumeration date:** 03/31/2020
- **Last updated:** 03/31/2020