Healthcare Provider Details

I. General information

NPI: 1851871370
Provider Name (Legal Business Name): MARIO JR MILLAN HEALTH ADULT DAYCARE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 11/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 WASHINGTON AVENUE
BELLEVILLE NJ
07109
US

IV. Provider business mailing address

114 WASHINGTON AVENUE
BELLEVILLE NJ
07109
US

V. Phone/Fax

Practice location:
  • Phone: 973-429-0525
  • Fax: 973-751-7704
Mailing address:
  • Phone: 973-336-4968
  • Fax: 973-751-7704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: