=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083399539
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PENN GARDENS ADS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2023
-----------------------------------------------------
Last Update Date | 06/21/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 320 S BROAD ST
-----------------------------------------------------
City | LANSDALE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19446-3819
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-647-6407
-----------------------------------------------------
Fax | 267-642-9328
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 320 S BROAD ST
-----------------------------------------------------
City | LANSDALE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19446-3819
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-647-6407
-----------------------------------------------------
Fax | 267-642-9328
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | MR. KISHAN PATEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 732-516-8163
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------