Healthcare Provider Details

I. General information

NPI: 1417428335
Provider Name (Legal Business Name): BERGEN ADULT DAY CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 12/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 E CENTRAL BLVD
PALISADES PARK NJ
07650-1730
US

IV. Provider business mailing address

139 E CENTRAL BLVD
PALISADES PARK NJ
07650-1730
US

V. Phone/Fax

Practice location:
  • Phone: 201-577-2886
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: CHLOE LEE
Title or Position: PRESIDENT
Credential:
Phone: 201-577-2886