=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346637956
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GOLDEN RETREAT ADULT DAY CARE CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/21/2015
-----------------------------------------------------
Last Update Date | 04/21/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 247 W RAMAPO AVE
-----------------------------------------------------
City | MAHWAH
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07430-1619
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-927-9434
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12 WINDING RDG
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07436-2317
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-927-9434
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. PRITI BHARGAVA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 201-927-9434
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------