Healthcare Provider Details

I. General information

NPI: 1235257940
Provider Name (Legal Business Name): HADDON HOUSE ADULT MEDICAL DAY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1470 HADDON AVE
CAMDEN NJ
08103-3121
US

IV. Provider business mailing address

1470 HADDON AVE
CAMDEN NJ
08103-3121
US

V. Phone/Fax

Practice location:
  • Phone: 856-964-3100
  • Fax: 856-964-3221
Mailing address:
  • Phone: 856-964-3100
  • Fax: 856-964-3221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number158335
License Number StateNJ

VIII. Authorized Official

Name: MR. ROOSEVELT NESMITH
Title or Position: MANAGING PARTNER
Credential:
Phone: 856-964-3100