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General NPI Number Information
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NPI Number | 1366821241
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Entity Type | Organization
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Legal Business Name | ACTIVE DAY ADULT SOCIAL SERVICES
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Dates
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Enumeration Date | 05/25/2015
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Last Update Date | 01/14/2016
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Provider Practice Location Address
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Address Line | 20 JACKSON ST STE 1A
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City | FREEHOLD
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State | NJ
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Zip | 07728-2476
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Country | US
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Telephone | 732-845-3332
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Fax | 732-845-3339
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Provider Business Mailing Address
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Address Line | 20 JACKSON ST STE 1A
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City | FREEHOLD
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State | NJ
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Zip | 07728-2476
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Country | US
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Telephone | 732-845-3332
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Fax | 732-845-3339
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Authorized Official
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Title or Position | MANAGER
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Name | TATIANA LARINA
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Credential |
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Telephone | 732-851-6640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 13008
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License Number State | NJ
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