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General NPI Number Information
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NPI Number | 1447680020
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Entity Type | Organization
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Legal Business Name | EPIC MEDICAL DAYCARE
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Dates
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Enumeration Date | 11/19/2013
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Last Update Date | 12/05/2013
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Provider Practice Location Address
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Address Line | 39 FOREST ST LOWER LEVEL
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City | MONTCLAIR
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State | NJ
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Zip | 07042-3550
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Country | US
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Telephone | 973-342-6904
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Fax |
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Provider Business Mailing Address
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Address Line | 39 FOREST ST LOWER LEVEL
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City | MONTCLAIR
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State | NJ
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Zip | 07042-3550
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Country | US
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Telephone | 973-342-6904
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NICOLE HARRIS
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Credential |
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Telephone | 973-342-6904
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number | R074780
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License Number State | NJ
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