Organization
BROADWAY RESPITE AND HOME CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANASTASIA VAYNBERG (BILLING MANAGER)
(201) 703-3980
Entity
Organization
Contact information
Practice address
621 CHROME ST, NORTH BRUNSWICK, NJ 08902-3303
(201) 703-3980
(201) 703-3984
Mailing address
17-17 BROADWAY, FAIR LAWN, NJ 07410
(201) 703-3980
(201) 703-3984
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0519049
—
NJ
Enumeration date
12/11/2019
Last updated
12/11/2019
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