Organization
BROADWAY GROUP HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER LOZANO (SVP FINANCIAL SERVICE)
(770) 630-7290
Entity
Organization
Contact information
Practice address
1215 LIVINGSTON AVE STE 200, NORTH BRUNSWICK, NJ 08902-3834
(201) 703-3980
(201) 703-3984
Mailing address
17-17 BROADWAY, FAIR LAWN, NJ 07410-2055
(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
Enumeration date
01/09/2023
Last updated
03/05/2024
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