Healthcare Provider Details

I. General information

NPI: 1063001626
Provider Name (Legal Business Name): SILVER CARE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2021
Last Update Date: 01/18/2021
Certification Date: 01/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 HENRY ST
LAKEWOOD NJ
08701-5148
US

IV. Provider business mailing address

1770 W COUNTY LINE RD UNIT 101
LAKEWOOD NJ
08701-1176
US

V. Phone/Fax

Practice location:
  • Phone: 732-419-8553
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CHAVA E ELLINSON
Title or Position: DIRECTOR
Credential:
Phone: 732-276-5828