Organization
ACHIDIMED LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GASTON A BOMA (PRESIDENT)
(202) 714-4399
Entity
Organization
Contact information
Practice address
2201 S CLINTON AVE STE 2F, SOUTH PLAINFIELD, NJ 07080-1473
(908) 462-4361
Mailing address
2201 S CLINTON AVE STE 2F, SOUTH PLAINFIELD, NJ 07080-1473
(908) 462-4361
Taxonomy
Speciality
Code
Description
License number
State
253J00000X
Foster Care Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
09/24/2019
Last updated
09/24/2019
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