Healthcare Provider Details

I. General information

NPI: 1043684285
Provider Name (Legal Business Name): PRASADA CENTER FOR WELLBEING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2015
Last Update Date: 11/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 E SHAWNEE TRL
WHARTON NJ
07885-2920
US

IV. Provider business mailing address

112 E SHAWNEE TRL
WHARTON NJ
07885-2920
US

V. Phone/Fax

Practice location:
  • Phone: 973-685-5668
  • Fax: 973-663-6030
Mailing address:
  • Phone: 973-685-5668
  • Fax: 973-663-6030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. KATHERINE V SHELDON
Title or Position: OWNER/DIRECTOR
Credential:
Phone: 973-685-5668