Organization
INNOVATIVE LIFE OF NEW JERSEY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHINAVIA MCKINNEY (COO)
(301) 270-4750
Entity
Organization
Contact information
Practice address
2511 HUNTERS GLEN DR, PLAINSBORO, NJ 08536-3869
(301) 270-4750
Mailing address
8484 GEORGIA AVE STE 900, SILVER SPRING, MD 20910-5604
(301) 270-4750
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
—
2511
—
NJ
Enumeration date
08/30/2021
Last updated
08/30/2021
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