Healthcare Provider Details

I. General information

NPI: 1972645034
Provider Name (Legal Business Name): FIVE STAR ADULT MEDICAL DAY CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 DEERFIELD TER
LINDEN NJ
07036-5523
US

IV. Provider business mailing address

1201 DEERFIELD TER
LINDEN NJ
07036-5523
US

V. Phone/Fax

Practice location:
  • Phone: 908-486-5750
  • Fax: 908-486-3325
Mailing address:
  • Phone: 908-486-5750
  • Fax: 908-486-3325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number908112
License Number StateNJ

VIII. Authorized Official

Name: MS. SVETLANA MARYASH
Title or Position: MANAGING MEMBER
Credential:
Phone: 908-486-5750