Thywill Support Connections

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

THYWILL SUPPORT CONNECTIONS

Practice address

615 Cutler Ave
Maple Shade, NJ 08052-2914

Phone

(908) 963-3628

Fax

(856) 382-7926

NPI assigned

Nov 7, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Cyril Dzidzeme Klutse

Title

Administrator

Phone

(908) 963-3628

Specialties & licenses 4

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1667779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667779200000",
    "number": "1053029314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 CUTLER AVE",
            "city": "MAPLE SHADE",
            "state": "NJ",
            "postal_code": "080522914",
            "telephone_number": "908-963-3628",
            "fax_number": "856-382-7926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 CUTLER AVE",
            "city": "MAPLE SHADE",
            "state": "NJ",
            "postal_code": "080522914",
            "telephone_number": "908-963-3628",
            "fax_number": "856-382-7926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THYWILL SUPPORT CONNECTIONS",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-07",
        "last_updated": "2022-11-07",
        "certification_date": "2022-11-06",
        "status": "A",
        "authorized_official_last_name": "KLUTSE",
        "authorized_official_first_name": "CYRIL",
        "authorized_official_middle_name": "DZIDZEME",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "908-963-3628",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "385HR2060X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Maple Shade, NJ
• Providers in Maple Shade, NJ by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2022; 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.