Provider Demographics
NPI:1629824917
Name:PRIDE DAY PROGRAM ECLC OF NJ
Entity type:Organization
Organization Name:PRIDE DAY PROGRAM ECLC OF NJ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHOCKLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-601-5323
Mailing Address - Street 1:100 PASSAIC AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-2848
Mailing Address - Country:US
Mailing Address - Phone:973-601-5330
Mailing Address - Fax:
Practice Address - Street 1:94 FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928-2338
Practice Address - Country:US
Practice Address - Phone:973-601-5330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIDE DAY PROGRAM ECLC OF NJ
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-26
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services