The Well Balanced Senior Program

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

License

0400239766 Issued in NJ

Legal business name

THE WELL BALANCED SENIOR PROGRAM

Practice address

111 South Munn Ave
Suite 2a
East Orange, NJ 07018

Phone

(908) 296-5258

Fax

(973) 732-0460

NPI assigned

Jul 10, 2008

Organization subpart

No

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

Authorized official

Name

Shelly Denise Larkins

Title

Executive Director

Phone

(908) 296-5258

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1215648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1258934400000",
    "number": "1457515207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 SOUTH MUNN AVE",
            "address_2": "SUITE 2A",
            "city": "EAST ORANGE",
            "state": "NJ",
            "postal_code": "07018",
            "telephone_number": "908-296-5258",
            "fax_number": "973-732-0460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 SOUTH MUNN AVE",
            "address_2": "SUITE 2A",
            "city": "EAST ORANGE",
            "state": "NJ",
            "postal_code": "07018",
            "telephone_number": "908-296-5258",
            "fax_number": "973-732-0460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE WELL BALANCED SENIOR PROGRAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-10",
        "last_updated": "2009-11-23",
        "status": "A",
        "authorized_official_last_name": "LARKINS",
        "authorized_official_first_name": "SHELLY",
        "authorized_official_middle_name": "DENISE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "908-296-5258"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Community Health Worker",
            "state": "NJ",
            "license": "0400239766",
            "primary": true
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NJ",
            "license": "HP0135400",
            "primary": false
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "NJ",
            "license": "0400239766",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2009; 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.