MEDICARE: PRIME TIME CENTER INC

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	251C00000X	Developmentally Disabled Services Day Training Agency		NJ

General Provider Information

NPI Number	:	1750761854
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME TIME CENTER INC

Provider Business Mailing Address
First Line	:	2210 W COUNTY LINE RD
Second Line	:
City	:	JACKSON
State	:	NJ
Zip	:	08527-2293
Country	:	US
Telephone Number	:	888-258-5271
Fax Number	:	732-541-2557

Provider Business Practice Location Address
First Line	:	60 HIGH ST
Second Line	:
City	:	CARTERET
State	:	NJ
Zip	:	07008-2653
Country	:	US
Telephone Number	:	888-258-5271
Fax Number	:	732-541-2557

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. RUTH H. REINHARD
Credential	:
Telephone Number	:	888-258-5271

Provider Enumeration Date	:	06/03/2015
Last Update Date	:	09/01/2017

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