Healthcare Provider Details

I. General information

NPI: 1750036661
Provider Name (Legal Business Name): HOLY DOVE CHRISTIAN FELLOWSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2022
Last Update Date: 02/18/2022
Certification Date: 02/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 STUYVESANT AVE
IRVINGTON NJ
07111-1116
US

IV. Provider business mailing address

915 STUYVESANT AVE
IRVINGTON NJ
07111-1116
US

V. Phone/Fax

Practice location:
  • Phone: 973-996-5575
  • Fax: 973-351-5443
Mailing address:
  • Phone: 973-996-5575
  • Fax: 973-351-5443

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: MS. THERESA AYERS
Title or Position: ADMINISTRATOR
Credential:
Phone: 973-996-5575