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General NPI Number Information
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NPI Number | 1558802488
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Entity Type | Organization
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Legal Business Name | CENTRAL WARD SOCIAL ADULT DAYCARE CENTER
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Dates
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Enumeration Date | 03/11/2017
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Last Update Date | 03/11/2017
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Provider Practice Location Address
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Address Line | 167 S 6TH ST
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City | NEWARK
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State | NJ
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Zip | 07103-2408
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Country | US
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Telephone | 973-842-5662
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Fax |
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Provider Business Mailing Address
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Address Line | 293 LITTLETON AVE
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City | NEWARK
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State | NJ
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Zip | 07103-2304
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Country | US
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Telephone | 973-842-5662
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Fax | 973-732-0775
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ANDRE SPEIGHT
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Credential | PHD
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Telephone | 973-842-5662
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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 | SOCIAL ADULT DAY CAR
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License Number State | NJ
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