Organization
LIVING NEW, REAL FAMILIES INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TYSHAMMIE COOPER DELISLE (MANAGER)
(973) 509-7600
Entity
Organization
Contact information
Practice address
15 SOUTH 9TH STREET, NEWARK, NJ 07102
(973) 497-9300
Mailing address
356 BLOOMFIELD AVE, MONTCLAIR, NJ 07042-3646
(973) 509-7600
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0125059
—
NJ
Enumeration date
08/24/2007
Last updated
08/24/2007
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