Healthcare Provider Details

I. General information

NPI: 1699329094
Provider Name (Legal Business Name): PRESTIGIOUS ADULT DAY CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2019
Last Update Date: 07/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 BROAD AVE STE 301
PALISADES PARK NJ
07650-1886
US

IV. Provider business mailing address

PO BOX 720475
BYRAM MS
39272-0475
US

V. Phone/Fax

Practice location:
  • Phone: 601-317-1417
  • Fax:
Mailing address:
  • Phone: 601-317-1417
  • 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: GWEN WALKER
Title or Position: CONSULTANT
Credential:
Phone: 601-317-1417