Healthcare Provider Details

I. General information

NPI: 1154203974
Provider Name (Legal Business Name): HOLMDEL ADULT MEDICAL DAY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2025
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2145 RTE 35
HOLMDEL NJ
07733-1164
US

IV. Provider business mailing address

2145 RTE 35
HOLMDEL NJ
07733-1164
US

V. Phone/Fax

Practice location:
  • Phone: 732-772-9041
  • Fax: 732-772-9042
Mailing address:
  • Phone: 201-951-5121
  • Fax:

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: NIVINE TITRE
Title or Position: ADMINISTRATOR
Credential: CALA
Phone: 201-951-5121