Healthcare Provider Details

I. General information

NPI: 1245617786
Provider Name (Legal Business Name): MT BETHEL DAY PROGRAM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2015
Last Update Date: 12/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 MOUNTAIN BLVD, SUITE 201
WARREN NJ
07059
US

IV. Provider business mailing address

316 SOUTH AVE
FANWOOD NJ
07023
US

V. Phone/Fax

Practice location:
  • Phone: 908-757-7000
  • Fax: 908-757-7022
Mailing address:
  • Phone: 908-889-4200
  • Fax: 908-889-4224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEENA SCHAFFER
Title or Position: CFO
Credential:
Phone: 908-889-4200