=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619322021
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SEVA SADAN LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2016
-----------------------------------------------------
Last Update Date | 05/04/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 165 AMHERST AVE
-----------------------------------------------------
City | COLONIA
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07067-2005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-983-2403
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 165 AMHERST AVE
-----------------------------------------------------
City | COLONIA
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07067-2005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COO
-----------------------------------------------------
Name | JIGNESH P PATEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 732-983-2403
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------