NPIMap

Organization Active NPI

Innovative Life of New Jersey

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Brick, NJ
National Provider Identifier
1356091722
Registry record updated Mar 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X
Legal business name
INNOVATIVE LIFE OF NEW JERSEY
Practice address
175 Chambers Bridge Rd Apt 143
Brick, NJ 08723-3504
Phone
(301) 270-4750
NPI assigned
Mar 28, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2022

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

Authorized official

Name
Shinavia McKinney
Title
Coo
Phone
(301) 270-4750

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X Primary

Addresses

Primary practice location

175 Chambers Bridge Rd Apt 143
Brick, NJ 08723-3504

Mailing address

8484 Georgia Ave Ste 900
Silver Spring, MD 20910-5604
Phone (301) 270-4750

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address accounting@innovativelife.org

National Provider Directory

National Provider Directory
Tax ID family
Innovative Life of New Jersey27 organizations share this tax ID, including this one

Other organizations with this tax ID 26

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

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1648425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648425600000",
    "number": "1356091722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8484 GEORGIA AVE STE 900",
            "city": "SILVER SPRING",
            "state": "MD",
            "postal_code": "209105604",
            "telephone_number": "301-270-4750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 CHAMBERS BRIDGE RD APT 143",
            "city": "BRICK",
            "state": "NJ",
            "postal_code": "087233504",
            "telephone_number": "301-270-4750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE LIFE OF NEW JERSEY",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-28",
        "last_updated": "2022-03-28",
        "certification_date": "2022-03-28",
        "status": "A",
        "authorized_official_last_name": "MCKINNEY",
        "authorized_official_first_name": "SHINAVIA",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "301-270-4750"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "accounting@innovativelife.org",
            "affiliation": "N",
            "endpointDescription": "email",
            "address_1": "175 Chambers Bridge Rd Apt 143",
            "city": "Brick",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "087233504",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Brick, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 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.