Healthcare Provider Details

I. General information

NPI: 1205172954
Provider Name (Legal Business Name): TOWN SQUARE ADULT MEDICAL DAY CARE CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2012
Last Update Date: 12/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 E JERSEY ST
ELIZABETH NJ
07201-2310
US

IV. Provider business mailing address

1155 E JERSEY ST
ELIZABETH NJ
07201-2310
US

V. Phone/Fax

Practice location:
  • Phone: 908-787-0980
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number20004
License Number StateNJ

VIII. Authorized Official

Name: JOAN MARIE GRANATO
Title or Position: OWNER
Credential:
Phone: 201-736-5301