Healthcare Provider Details

I. General information

NPI: 1083848642
Provider Name (Legal Business Name): SALEM ADULT DAY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2009
Last Update Date: 05/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53-55 S BROAD ST
PENNS GROVE NJ
08069-1603
US

IV. Provider business mailing address

53-55 S BROAD ST
PENNS GROVE NJ
08069-1603
US

V. Phone/Fax

Practice location:
  • Phone: 856-299-1111
  • Fax:
Mailing address:
  • Phone: 856-299-1111
  • 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: JENNIFER BUCOLO
Title or Position: ADMINISTRATOR
Credential: LNHA
Phone: 856-299-1111