Healthcare Provider Details

I. General information

NPI: 1457849416
Provider Name (Legal Business Name): NAZARENE COMMUNITY DEVELOPMENT FOUNDATION INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2018
Last Update Date: 04/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S 8TH ST
CAMDEN NJ
08104-1424
US

IV. Provider business mailing address

1500 S 8TH ST
CAMDEN NJ
08104-1424
US

V. Phone/Fax

Practice location:
  • Phone: 856-365-0642
  • Fax:
Mailing address:
  • Phone: 856-365-0642
  • Fax:

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: DYHEIM WATSON SR.
Title or Position: CEO
Credential:
Phone: 856-365-0642