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General NPI Number Information
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NPI Number | 1528059656
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Entity Type | Organization
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Legal Business Name | WILEY CHRISTIAN ADULT DAY SERVICES, INC.
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Dates
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Enumeration Date | 10/28/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6103 WESTFIELD AVE
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City | PENNSAUKEN
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State | NJ
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Zip | 08110-1754
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Country | US
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Telephone | 856-486-9737
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Fax | 856-486-1098
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Provider Business Mailing Address
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Address Line | 99 E MAIN ST
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City | MARLTON
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State | NJ
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Zip | 08053-2122
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Country | US
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Telephone | 856-983-0411
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Fax | 856-985-4655
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Authorized Official
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Title or Position | CEO
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Name | MR. GARY F GILMORE
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Credential |
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Telephone | 856-983-0411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 080473
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License Number State | NJ
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