Healthcare Provider Details

I. General information

NPI: 1275017816
Provider Name (Legal Business Name): SHREWSBURY HEALTH ADULT DAYCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2018
Last Update Date: 12/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 WASHINGTON AVE
BELLEVILLE NJ
07109-2926
US

IV. Provider business mailing address

114 WASHINGTON AVE
BELLEVILLE NJ
07109-2926
US

V. Phone/Fax

Practice location:
  • Phone: 973-336-4968
  • Fax:
Mailing address:
  • Phone: 973-336-4968
  • Fax: 973-302-7667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARIO MILLAN
Title or Position: OWER
Credential:
Phone: 973-336-4968