MEDICARE: CLAYMONT ADULT DAY CARE CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1225727068
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLAYMONT ADULT DAY CARE CENTER LLC

Provider Business Mailing Address
First Line	:	414 LAUREL CREEK BLVD
Second Line	:
City	:	MOORESTOWN
State	:	NJ
Zip	:	08057-3968
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 PHILADELPHIA PIKE STE B
Second Line	:
City	:	CLAYMONT
State	:	DE
Zip	:	19703-2431
Country	:	US
Telephone Number	:	302-404-3888
Fax Number	:	302-291-4986

Authorized Official
Title or Position	:	OWNER
Name	:	XIN LIU
Credential	:
Telephone Number	:	302-404-3888

Provider Enumeration Date	:	05/08/2023
Last Update Date	:	06/24/2023

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