Healthcare Provider Details

I. General information

NPI: 1376766493
Provider Name (Legal Business Name): SENIOR CARE & ACTIVITIES CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 GREENWOOD AVE
MONTCLAIR NJ
07042-4010
US

IV. Provider business mailing address

110 GREENWOOD AVE
MONTCLAIR NJ
07042-4010
US

V. Phone/Fax

Practice location:
  • Phone: 973-783-5589
  • Fax: 973-783-3711
Mailing address:
  • Phone: 973-783-5589
  • Fax: 973-783-3711

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. FREDERICK ROBERT JENNY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 973-783-5589