Healthcare Provider Details

I. General information

NPI: 1699953406
Provider Name (Legal Business Name): PROVIDENCE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2008
Last Update Date: 02/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 W UPPER FERRY RD
EWING NJ
08628-2736
US

IV. Provider business mailing address

80 W UPPER FERRY RD
EWING NJ
08628-2736
US

V. Phone/Fax

Practice location:
  • Phone: 732-942-6400
  • Fax:
Mailing address:
  • Phone: 732-942-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. SIMON FRIDMANN
Title or Position: OWNER
Credential:
Phone: 732-942-6400