Healthcare Provider Details

I. General information

NPI: 1114266178
Provider Name (Legal Business Name): RISING STAR ADULT DAY CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2013
Last Update Date: 02/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1980 N OLDEN AVENUE EXT
EWING NJ
08618-2116
US

IV. Provider business mailing address

22 MERIDIAN RD SUITE #10
EDISON NJ
08820-2860
US

V. Phone/Fax

Practice location:
  • Phone: 732-979-4512
  • Fax:
Mailing address:
  • Phone: 732-951-2020
  • Fax: 732-951-2307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number11007
License Number StateNJ

VIII. Authorized Official

Name: MRS. SEJAL DASONDI
Title or Position: DIRECTOR
Credential: CALA
Phone: 732-207-0610