Healthcare Provider Details

I. General information

NPI: 1851721708
Provider Name (Legal Business Name): VICTORIAN GARDEN ADULT DAY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2013
Last Update Date: 11/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 MAIN ST
CHATHAM NJ
07928-2229
US

IV. Provider business mailing address

353 MAIN ST
CHATHAM NJ
07928-2229
US

V. Phone/Fax

Practice location:
  • Phone: 973-635-2266
  • Fax: 973-635-0108
Mailing address:
  • Phone: 973-635-2266
  • Fax: 973-635-0108

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: MRS. PHYLLIS MARYANN FLEMMING
Title or Position: OWNER/EXECUTIVE DIRECTOR
Credential: CDP
Phone: 973-635-2266