NPIMap

Organization Active NPI

Beacon Specialized Living New Jersey, Inc.

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Neptune, NJ
National Provider Identifier
1023717857
Registry record updated Mar 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
Legal business name
BEACON SPECIALIZED LIVING NEW JERSEY, INC.
Practice address
26 Roberts Dr
Neptune, NJ 07753-3223
Phone
(732) 918-2034
NPI assigned
Mar 1, 2023
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Darren Hodgdon
Title
Chief Executive Officer
Phone
(269) 427-8400

Corporate family (same tax ID) 13

Organizations that report the same tax identification number in the National Provider Directory.

National Provider Directory

National Provider Directory
Tax ID family
Beacon Specialized Living New Jersey Inc (61 organizations share this tax ID)

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X Primary

Addresses

NPPES NPI Registry

Primary practice location

26 Roberts Dr
Neptune, NJ 07753-3223

Mailing address

13 Roszel Rd Ste B110
Princeton, NJ 08540-6211
Phone (609) 987-5003

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
0450858187MedicaidNJ

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 2, 2023.

{
    "created_epoch": "1677628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677715200000",
    "number": "1023717857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13 ROSZEL RD STE B110",
            "city": "PRINCETON",
            "state": "NJ",
            "postal_code": "085406211",
            "telephone_number": "609-987-5003",
            "fax_number": "609-520-7979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26 ROBERTS DR",
            "city": "NEPTUNE",
            "state": "NJ",
            "postal_code": "077533223",
            "telephone_number": "732-918-2034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACON SPECIALIZED LIVING NEW JERSEY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-01",
        "last_updated": "2023-03-02",
        "certification_date": "2023-03-02",
        "status": "A",
        "authorized_official_last_name": "HODGDON",
        "authorized_official_first_name": "DARREN",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "269-427-8400"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0450858187",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Neptune, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.