Healthcare Provider Details

I. General information

NPI: 1003729328
Provider Name (Legal Business Name): MICA GENTLEHEART ADULT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2026
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1404 OAK TREE RD
ISELIN NJ
08830-1656
US

IV. Provider business mailing address

1404 OAK TREE RD
ISELIN NJ
08830-1656
US

V. Phone/Fax

Practice location:
  • Phone: 786-271-0898
  • Fax:
Mailing address:
  • Phone: 786-271-0898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. DATUDE DIORNE EXANTUS
Title or Position: CEO/OWNER
Credential:
Phone: 786-271-0898