Organization
AVIDD COMMUNITY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERRENCE MCKEON (EXECUTIVE DIRECTOR)
(973) 886-1953
Entity
Organization
Contact information
Practice address
74 VILLAGE GRN APT 26G, BUDD LAKE, NJ 07828-1379
(973) 664-1770
Mailing address
92 BROADWAY STE 101, DENVILLE, NJ 07834-2733
(973) 664-1770
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
—
0530549
—
NJ
Enumeration date
04/29/2020
Last updated
04/29/2020
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