Healthcare Provider Details

I. General information

NPI: 1477058568
Provider Name (Legal Business Name): PRASADA CENTER FOR WELLBEING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 03/29/2018
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: 866-686-3057
Mailing address:
  • Phone: 973-685-5668
  • Fax: 866-686-3057

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
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

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