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
20 LOWER MATCHAPONIX ANE, MONROE, NJ 08831
(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
03/02/2018
Last updated
03/02/2018
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