Healthcare Provider Details

I. General information

NPI: 1184143521
Provider Name (Legal Business Name): FREEHOLD MONTCLAIR HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2017
Last Update Date: 09/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 GREENWOOD AVE
MONTCLAIR NJ
07042-4010
US

IV. Provider business mailing address

40 VREELAND AVE STE 101A
TOTOWA NJ
07512-1169
US

V. Phone/Fax

Practice location:
  • Phone: 973-783-5589
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number308119
License Number StateNJ

VIII. Authorized Official

Name: MR. ROBERT FRANK NOTTE
Title or Position: PRESIDENT
Credential:
Phone: 973-812-9777