Provider Demographics
NPI: | 1487366589 |
---|---|
Name: | GREAT INTEGRITY LLC |
Entity type: | Organization |
Organization Name: | GREAT INTEGRITY LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SHAJMARA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | RHODES |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 908-875-3204 |
Mailing Address - Street 1: | 46 W 12TH ST, LINDEN, NJ 07036 |
Mailing Address - Street 2: | |
Mailing Address - City: | LINDEN |
Mailing Address - State: | NJ |
Mailing Address - Zip Code: | 07036-4602 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 908-875-3204 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 46 W 12TH ST, LINDEN, NJ 07036 |
Practice Address - Street 2: | |
Practice Address - City: | LINDEN |
Practice Address - State: | NJ |
Practice Address - Zip Code: | 07036-0703 |
Practice Address - Country: | US |
Practice Address - Phone: | 908-875-3204 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2022-12-20 |
Last Update Date: | 2022-12-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
No | 261QD1600X | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities |
No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No | 310500000X | Nursing & Custodial Care Facilities | Intermediate Care Facility, Mental Illness | |
No | 320600000X | Residential Treatment Facilities | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
No | 320700000X | Residential Treatment Facilities | Residential Treatment Facility, Physical Disabilities | |
No | 251E00000X | Agencies | Home Health | |
No | 320900000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
No | 320800000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NJ | 0450822501 | Other | DDD |
NJ | 0450822501 | Other | GROUP HOME |
NJ | 0450822501 | Medicaid |