Organization
BROADWAY RESPITE AND HOME CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANASTASIA VAYNBERG (MANAGER)
(201) 703-3980
Entity
Organization
Contact information
Practice address
89 BOONTON AVENUE, KINNELON, NJ 07405
(973) 291-6374
(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
GH2140
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0519049
—
NJ
Enumeration date
09/25/2017
Last updated
09/25/2017
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