Healthcare Provider Details

I. General information

NPI: 1780952671
Provider Name (Legal Business Name): SELAH CARE CENTER A NJ NON-PROFIT ORG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2011
Last Update Date: 03/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 MAIN STREET
LEWISTON ME
04240
US

IV. Provider business mailing address

443 SCHOOLEYS MOUNTAIN RD
HACKETTSTOWN NJ
07840-4023
US

V. Phone/Fax

Practice location:
  • Phone: 207-513-5150
  • Fax:
Mailing address:
  • Phone: 908-850-0099
  • Fax: 908-269-8769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateME

VIII. Authorized Official

Name: DARLENE TRANQUILLI
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 908-850-0099