Healthcare Provider Details

I. General information

NPI: 1659624286
Provider Name (Legal Business Name): BUCKINGHAM PLACE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2012
Last Update Date: 02/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 WOODS LN
MONMOUTH JUNCTION NJ
08852-2177
US

IV. Provider business mailing address

700 WOODS LN
MONMOUTH JUNCTION NJ
08852-2177
US

V. Phone/Fax

Practice location:
  • Phone: 732-329-8954
  • Fax: 732-329-9225
Mailing address:
  • Phone: 732-329-8954
  • Fax: 732-329-9225

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: DEAN PAUL VLECIDES
Title or Position: ADMINISTRATOR
Credential:
Phone: 732-329-8954