Healthcare Provider Details

I. General information

NPI: 1528199551
Provider Name (Legal Business Name): CLARENDON GARDENS SOCIAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 CLIFTON AVE
NEWARK NJ
07104-1907
US

IV. Provider business mailing address

212 CLIFTON AVE
NEWARK NJ
07104-1907
US

V. Phone/Fax

Practice location:
  • Phone: 973-481-6516
  • Fax:
Mailing address:
  • Phone: 973-481-6516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MRS. ROCHELLE ANDREE SMITH
Title or Position: MANAGING MEMBER
Credential:
Phone: 973-481-6516