Organization
LIVING NEW INC
Active
Other names
real families inc
Organization subpart
No
Provider details
NPI number
Authorized official
TYSHAMMIE COOPER-DELISLE (ADMINISTRATOR/CFO)
(973) 497-2471
Entity
Organization
Contact information
Practice address
15 S 9TH ST, NEWARK, NJ 07107-2147
(973) 497-2471
Mailing address
356 BLOOMFIELD AVE, MONTCLAIR, NJ 07042-3646
(973) 497-2475
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
20003193-06
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0125059
—
NJ
Enumeration date
07/11/2008
Last updated
07/11/2008
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