Healthcare Provider Details

I. General information

NPI: 1417096157
Provider Name (Legal Business Name): PASSAIC COUNTY ELKS ADULT TRAINING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 US HIGHWAY 46
CLIFTON NJ
07013-1503
US

IV. Provider business mailing address

600 US HIGHWAY 46
CLIFTON NJ
07013-1503
US

V. Phone/Fax

Practice location:
  • Phone: 973-478-6655
  • Fax:
Mailing address:
  • Phone: 973-478-6655
  • 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: MS. STEPHANIE RICHVALSKY
Title or Position: SUPERVISOR
Credential:
Phone: 973-478-6655