Healthcare Provider Details

I. General information

NPI: 1124260260
Provider Name (Legal Business Name): VANNA ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2009
Last Update Date: 04/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 DRAKE RD
SOMERSET NJ
08873-2369
US

IV. Provider business mailing address

225 N CENTER DR
NORTH BRUNSWICK NJ
08902-4247
US

V. Phone/Fax

Practice location:
  • Phone: 732-809-7214
  • Fax:
Mailing address:
  • Phone: 732-951-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNJ

VIII. Authorized Official

Name: MRS. BERNADETTE DIAZ PECHILIO
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 732-951-2020