Healthcare Provider Details

I. General information

NPI: 1578945077
Provider Name (Legal Business Name): M. SANDERS & ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2015
Last Update Date: 06/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 CHAPEL AVE W
CHERRY HILL NJ
08002-2305
US

IV. Provider business mailing address

PO BOX 700538
SAINT CLOUD FL
34770-0538
US

V. Phone/Fax

Practice location:
  • Phone: 856-426-3635
  • Fax: 407-593-1771
Mailing address:
  • Phone: 305-972-1026
  • Fax: 407-593-1771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: MARCIE SANDERS
Title or Position: CEO/PRESIDENT
Credential:
Phone: 305-972-1026