MEDICARE: ST. ANN'S ADULT MEDICAL DAY CARE

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	408330	NJ

General Provider Information

NPI Number	:	1316338452
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. ANN'S ADULT MEDICAL DAY CARE

Provider Business Mailing Address
First Line	:	198 OLD BERGEN RD
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07305-2622
Country	:	US
Telephone Number	:	201-433-0950
Fax Number	:	201-985-9638

Provider Business Practice Location Address
First Line	:	198 OLD BERGEN RD
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07305-2622
Country	:	US
Telephone Number	:	201-433-0950
Fax Number	:	201-985-9638

Authorized Official
Title or Position	:	ADMINISTRATIOR
Name	:	MS. JANET MERLY-LIRANZO
Credential	:	LNHA
Telephone Number	:	201-433-0950

Provider Enumeration Date	:	02/11/2015
Last Update Date	:	02/11/2015

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