Organization
THYWILL SUPPORT CONNECTIONS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CYRIL DZIDZEME KLUTSE (ADMINISTRATOR)
(908) 963-3628
Entity
Organization
Contact information
Practice address
615 CUTLER AVE, MAPLE SHADE, NJ 08052-2914
(908) 963-3628
(856) 382-7926
Mailing address
615 CUTLER AVE, MAPLE SHADE, NJ 08052-2914
(908) 963-3628
(856) 382-7926
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Enumeration date
11/07/2022
Last updated
11/07/2022
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