NPIMap

Organization Active NPI

Innovative Life of New Jersey

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Eatontown, NJ
National Provider Identifier
1871176826
Registry record updated Apr 28, 2021
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
158A Eatoncrest Dr
Eatontown, NJ 07724-1261
Phone
(609) 526-3900
NPI assigned
Apr 28, 2021
Last updated
Apr 28, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2021

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

Authorized official

Name
Shinavia McKinney
Title
Executive Director
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

158A Eatoncrest Dr
Eatontown, NJ 07724-1261

Mailing address

1900 Mount Holly Rd Ste 600a
Burlington, NJ 08016-4722
Phone (609) 526-3900

Other identifiers 1

IdentifierTypeStateIssuer
0726524MedicaidNJ

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": "1619568000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619568000000",
    "number": "1871176826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 MOUNT HOLLY RD STE 600A",
            "city": "BURLINGTON",
            "state": "NJ",
            "postal_code": "080164722",
            "telephone_number": "609-526-3900",
            "fax_number": "301-264-1154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "158A EATONCREST DR",
            "city": "EATONTOWN",
            "state": "NJ",
            "postal_code": "077241261",
            "telephone_number": "609-526-3900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE LIFE OF NEW JERSEY",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-28",
        "last_updated": "2021-04-28",
        "certification_date": "2021-04-28",
        "status": "A",
        "authorized_official_last_name": "MCKINNEY",
        "authorized_official_first_name": "SHINAVIA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0726524",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Eatontown, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2021; 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.