Healthcare Provider Details

I. General information

NPI: 1881454221
Provider Name (Legal Business Name): LEBANON ADULT DAY CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2024
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

924 RUSSELL DR
LEBANON PA
17042-7485
US

IV. Provider business mailing address

12 HAMBLETONIAN DR
COLTS NECK NJ
07722-2123
US

V. Phone/Fax

Practice location:
  • Phone: 732-284-6020
  • Fax:
Mailing address:
  • Phone: 732-284-6020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ASHISH DESAI
Title or Position: OWNER
Credential:
Phone: 732-439-3674