Healthcare Provider Details

I. General information

NPI: 1053437434
Provider Name (Legal Business Name): HEALTH GUARD ADHC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 E 1ST AVE
ROSELLE NJ
07203-1571
US

IV. Provider business mailing address

545 E 1ST AVE
ROSELLE NJ
07203-1571
US

V. Phone/Fax

Practice location:
  • Phone: 908-298-8588
  • Fax: 908-298-8511
Mailing address:
  • Phone: 908-298-8588
  • Fax: 908-298-8511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number908115
License Number StateNJ

VIII. Authorized Official

Name: MS. FRIDA VAYSMAN
Title or Position: PARTNER
Credential:
Phone: 908-298-8588