Achidimed LLC

Primary specialty

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

Legal business name

ACHIDIMED LLC

Practice address

2201 S Clinton Ave Ste 2F
South Plainfield, NJ 07080-1473

Phone

(908) 462-4361

NPI assigned

Sep 24, 2019

Last updated

Sep 24, 2019By 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

Gaston A BomaNPI 1316592090

Title

President

Phone

(202) 714-4399

Specialties & licenses 4

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Gaston Achidi Boma

  • Developmentally Disabled Services Day Training Agency
  • South Plainfield, NJ
  • NPI 1316592090

  In Home Supportive Care

  NPD Authorized official

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

{
    "created_epoch": "1569283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1569283200000",
    "number": "1922659713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2201 S CLINTON AVE STE 2F",
            "city": "SOUTH PLAINFIELD",
            "state": "NJ",
            "postal_code": "070801473",
            "telephone_number": "908-462-4361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2201 S CLINTON AVE STE 2F",
            "city": "SOUTH PLAINFIELD",
            "state": "NJ",
            "postal_code": "070801473",
            "telephone_number": "908-462-4361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACHIDIMED LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-24",
        "last_updated": "2019-09-24",
        "status": "A",
        "authorized_official_last_name": "BOMA",
        "authorized_official_first_name": "GASTON",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "202-714-4399"
    },
    "taxonomies": [
        {
            "code": "253J00000X",
            "taxonomy_group": "",
            "desc": "Foster Care Agency",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in South Plainfield, NJ
• Providers in South Plainfield, 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 Sep 24, 2019; 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.