Healthcare Provider Details

I. General information

NPI: 1124270558
Provider Name (Legal Business Name): EDISON ADULT DAY CARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2008
Last Update Date: 10/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 OAK TREE RD STE 150
EDISON NJ
08820-2843
US

IV. Provider business mailing address

1655 OAK TREE RD STE 150
EDISON NJ
08820-2843
US

V. Phone/Fax

Practice location:
  • Phone: 732-494-1001
  • Fax:
Mailing address:
  • Phone: 732-494-1001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number12010
License Number StateNJ

VIII. Authorized Official

Name: DEBORAH A REDINGER
Title or Position: ADMINISTRATOR
Credential: LNHA
Phone: 732-494-1001