Ebony Island Shelter Company

Primary specialty

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

License

V58475691600 Issued in NJ

Legal business name

EBONY ISLAND SHELTER COMPANY

Practice address

127 Eastmont LN
Sicklerville, NJ 08081-1913

Phone

(856) 262-7396

Fax

(856) 262-8691

NPI assigned

Jul 19, 2010

Last updated

Jul 19, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. John Hagans

Title

President

Phone

(856) 262-7396

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1279497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1279497600000",
    "number": "1437462504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "127 EASTMONT LN",
            "city": "SICKLERVILLE",
            "state": "NJ",
            "postal_code": "080811913",
            "telephone_number": "856-262-7396",
            "fax_number": "856-262-8691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "127 EASTMONT LN",
            "city": "SICKLERVILLE",
            "state": "NJ",
            "postal_code": "080811913",
            "telephone_number": "856-262-7396",
            "fax_number": "856-262-8691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EBONY ISLAND SHELTER COMPANY",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-19",
        "last_updated": "2010-07-19",
        "status": "A",
        "authorized_official_last_name": "HAGANS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "856-262-7396",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NJ",
            "license": "V58475691600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rosemarie Katherine Dziedzic, D.C.
• E&S Medical Transportation
• Christina Eadicicco
• Eating Disorder & Anxiety Center of New Jersey
• Uzoma Ebisike
• Kevin K Echevarria
• Eckerd Corporation (Rite Aid Pharmacy 10467)
• Eckerd Corporation (Rite Aid Pharmacy 10463)
• Anne Edelman
• Sirmera Edmonds, LCADC

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Sicklerville, NJ
• Providers in Sicklerville, 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 Jul 19, 2010; 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.