Organization
PREMIUM RESIDENTIAL LIVING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LESLIE MARTINEZ MARTINEZ (OWNER)
(347) 742-5642
Entity
Organization
Contact information
Practice address
80 MAPLE AVE, IRVINGTON, NJ 07111-4322
(347) 742-5642
Mailing address
80 MAPLE AVE, IRVINGTON, NJ 07111-4322
(347) 742-5642
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
05/12/2026
Last updated
05/12/2026
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