Broadway Group Home LLC
Organization Active NPI Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Lodi, NJ
NPI 1154037604 · NPPES record last updated Jan 27, 2023
Key facts
- NPI
- 1154037604
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X
- Legal business name
- BROADWAY GROUP HOME LLC
- Practice address
- 16 Gunther Ave
Lodi, NJ 07644-2015 - Phone
- (973) 546-0488
- NPI assigned
- Jan 27, 2023
- Organization subpart
- No
Authorized official
- Name
- Patrick Patton
- Title
- Coo
- Phone
- (973) 546-0488
Corporate family (same tax ID) 13
National Provider Directory
- Tax ID family
- Broadway Group Home LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility | 320900000X | Yes |
Addresses
Primary practice location
16 Gunther Ave
Lodi, NJ 07644-2015
Mailing address
17-17 Broadway
Fair Lawn, NJ 07410-2055
Phone (201) 703-3980
Other providers in Lodi, NJ
- Tracy Biegel
- Blueren Health and Wellness, LLC
- James C Bonardi
- Samantha E Boustani
- Bright Side Counseling & Psychotherapy
- Broadway Respite and Home Care, LLC
- Alexa Buffington
- Ana Mariel Builes
- Christian Omar Cabrera
- Anthony J Campanella
All providers in Lodi, NJ · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 27, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.