Healthcare Provider Details

I. General information

NPI: 1043786254
Provider Name (Legal Business Name): ADULT FAMILY HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2018
Last Update Date: 12/24/2020
Certification Date: 12/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 ORCHARD ST
CLIFTON NJ
07013-1832
US

IV. Provider business mailing address

53 ORCHARD ST
CLIFTON NJ
07013-1832
US

V. Phone/Fax

Practice location:
  • Phone: 973-773-7600
  • Fax: 973-773-7011
Mailing address:
  • Phone: 973-773-7600
  • Fax: 973-773-7011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: VIKTORIYA FINE
Title or Position: CEO
Credential:
Phone: 973-773-7600