Healthcare Provider Details

I. General information

NPI: 1487052346
Provider Name (Legal Business Name): NEW AGE ADULT DAY CARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2014
Last Update Date: 12/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 BUCK RD SUITE 12
HUNTINGDON VALLEY PA
19006-1501
US

IV. Provider business mailing address

55 BUCK RD SUITE 12
HUNTINGDON VALLEY PA
19006-1501
US

V. Phone/Fax

Practice location:
  • Phone: 215-518-9998
  • Fax: 215-396-6650
Mailing address:
  • Phone: 215-518-9998
  • Fax: 215-396-6650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number295424
License Number StatePA

VIII. Authorized Official

Name: YELENA MARMUR
Title or Position: NURSING SUPERVISOR
Credential:
Phone: 215-518-9998