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General NPI Number Information
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NPI Number | 1548620701
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Entity Type | Organization
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Legal Business Name | WISHING WELL ADULT DAY HEALTH CARE, LLC
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Dates
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Enumeration Date | 03/02/2016
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Last Update Date | 03/02/2016
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Provider Practice Location Address
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Address Line | 3450 PRINCETON PIKE STE 120
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City | LAWRENCEVILLE
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State | NJ
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Zip | 08648-1206
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Country | US
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Telephone | 732-242-9741
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Fax | 732-242-9741
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Provider Business Mailing Address
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Address Line | 3450 PRINCETON PIKE STE 120
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City | LAWRENCEVILLE
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State | NJ
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Zip | 08648-1206
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Country | US
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Telephone | 732-242-9741
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Fax | 732-242-9741
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Authorized Official
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Title or Position | DIRECTOR OF NURSING
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Name | MRS. DENISE O'CONNOR
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Credential | RN
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Telephone | 732-856-3778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 11012
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License Number State | NJ
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