Organization
INNOVATIVE LIFE OF NEW JERSEY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHINAVIA MCKINNEY (EXECUTIVE DIRECTOR)
(301) 270-4750
Entity
Organization
Contact information
Practice address
158A EATONCREST DR, EATONTOWN, NJ 07724-1261
(609) 526-3900
Mailing address
1900 MOUNT HOLLY RD STE 600A, BURLINGTON, NJ 08016-4722
(609) 526-3900
(301) 264-1154
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
—
0726524
—
NJ
Enumeration date
04/28/2021
Last updated
04/28/2021
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