Healthcare Provider Details

I. General information

NPI: 1033590070
Provider Name (Legal Business Name): SENIOR STAR CORP. DAY HAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2015
Last Update Date: 08/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1676 N OLDEN AVE
EWING NJ
08638-3209
US

IV. Provider business mailing address

1676 N OLDEN AVE
EWING NJ
08638-3209
US

V. Phone/Fax

Practice location:
  • Phone: 609-434-0041
  • Fax: 609-434-0043
Mailing address:
  • Phone: 609-434-0041
  • Fax: 609-434-0043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. JULIA KIPNIS
Title or Position: PRESIDENT
Credential:
Phone: 609-434-0041