Organization Active NPI

Pennreach

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Woodbridge, NJ
National Provider Identifier
1063066470
Registry record updated Jul 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
Legal business name
PENNREACH
Practice address
1482 Rahway Avenue
Apt 114
Woodbridge, NJ 17001-0850
Phone
(215) 409-5519
NPI assigned
Jul 25, 2019
Last updated
Jul 25, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2019

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

Authorized official

Name
Krystal Odell
Title
Ceo
Phone
(215) 409-5519

Specialties & licenses 1

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

Addresses

Primary practice location

1482 Rahway Avenue
Apt 114
Woodbridge, NJ 17001-0850

Mailing address

18 S Main St
Allentown, NJ 08501-1610

National Provider Directory

National Provider Directory
Tax ID family
Pennreach87 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 19

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1564012800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1564012800000",
    "number": "1063066470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18 S MAIN ST",
            "city": "ALLENTOWN",
            "state": "NJ",
            "postal_code": "085011610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1482 RAHWAY AVENUE",
            "address_2": "APT 114",
            "city": "WOODBRIDGE",
            "state": "NJ",
            "postal_code": "170010850",
            "telephone_number": "215-409-5519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENNREACH",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-25",
        "last_updated": "2019-07-25",
        "status": "A",
        "authorized_official_last_name": "ODELL",
        "authorized_official_first_name": "KRYSTAL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "215-409-5519"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbridge, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2019; 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.