Healthcare Provider Details

I. General information

NPI: 1811358666
Provider Name (Legal Business Name): PRIDE DAY PROGRAM ECLC OF NJ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2016
Last Update Date: 03/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 SETTE DR
PARAMUS NJ
07652-2912
US

IV. Provider business mailing address

100 PASSAIC AVE
CHATHAM NJ
07928
US

V. Phone/Fax

Practice location:
  • Phone: 201-265-1040
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. DOROTHEA S. LIBMAN
Title or Position: DIRECTOR
Credential:
Phone: 973-665-4558