Healthcare Provider Details

I. General information

NPI: 1497176341
Provider Name (Legal Business Name): SEACREST VILLAGE ADULT DAY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2013
Last Update Date: 12/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 CENTER ST
LITTLE EGG HARBOR TWP NJ
08087-1347
US

IV. Provider business mailing address

1001 CENTER ST
LITTLE EGG HARBOR TWP NJ
08087-1347
US

V. Phone/Fax

Practice location:
  • Phone: 609-296-9292
  • Fax: 609-296-0508
Mailing address:
  • Phone: 609-296-9292
  • Fax: 609-296-0508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number658333
License Number StateNJ

VIII. Authorized Official

Name: MRS. MICHELLE P MEDORA
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 609-296-9292