Organization
PHASEBDEVELOPMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GREGG ALLEN REDMON MA, MED (COO)
(646) 512-1620
Entity
Organization
Contact information
Practice address
138 CENTRAL AVE, JERSEY CITY, NJ 07306-2119
(646) 512-1620
Mailing address
138 CENTRAL AVE, JERSEY CITY, NJ 07306-2119
(646) 512-1620
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
239456258
NY
Other
Enumeration date
11/14/2008
Last updated
11/14/2008
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