MEDICARE: CENTURY ADULT DAY HEALTH SERVICES, 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	:	1588081327
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTURY ADULT DAY HEALTH SERVICES, LLC

Provider Business Mailing Address
First Line	:	141 S CENTRE ST
Second Line	:
City	:	SOUTH ORANGE
State	:	NJ
Zip	:	07079-2609
Country	:	US
Telephone Number	:	973-325-0229
Fax Number	:

Provider Business Practice Location Address
First Line	:	16 LINDSLEY AVE
Second Line	:
City	:	WEST ORANGE
State	:	NJ
Zip	:	07052-5310
Country	:	US
Telephone Number	:	973-325-0229
Fax Number	:

Authorized Official
Title or Position	:	OFFICER
Name	:	MR. BURT LACIVITA
Credential	:	MS OTR
Telephone Number	:	201-923-7533

Provider Enumeration Date	:	03/18/2014
Last Update Date	:	03/18/2014

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