Healthcare Provider Details

I. General information

NPI: 1508214099
Provider Name (Legal Business Name): DIAMOND YEARS ADULT MEDICAL DAY CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2016
Last Update Date: 05/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 WEST CLINTON STREET
HALEDON NJ
07508
US

IV. Provider business mailing address

360 WEST CLINTON STREET
HALEDON NJ
07508
US

V. Phone/Fax

Practice location:
  • Phone: 973-942-4111
  • Fax: 973-942-0111
Mailing address:
  • Phone: 973-942-4111
  • Fax: 973-942-0111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: EUGENA KIM
Title or Position: ADMINISTRATOR
Credential:
Phone: 973-942-4111