=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336846005
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEART TO HEART DAY HABILITATION PROGRAM LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2023
-----------------------------------------------------
Last Update Date | 02/16/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 433 WOODBURY GLASSBORO RD
-----------------------------------------------------
City | SEWELL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08080-4559
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-697-4445
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 576 CENTRAL AVE STE 301
-----------------------------------------------------
City | EAST ORANGE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07018-1943
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-697-4445
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MOSHE ROSENBERG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 917-697-4445
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251C00000X
-----------------------------------------------------
Taxonomy Name | Developmentally Disabled Services Day Training Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------