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General NPI Number Information
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NPI Number | 1659779221
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Entity Type | Organization
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Legal Business Name | SENIOR SKIN CARE, LLC
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Dates
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Enumeration Date | 12/15/2014
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Last Update Date | 02/13/2015
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Provider Practice Location Address
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Address Line | 198 CHANGEWATER ROAD
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City | CHANGEWATER
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State | NJ
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Zip | 07831
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Country | US
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Telephone | 908-391-2548
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Fax |
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Provider Business Mailing Address
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Address Line | 198 CHANGEWATER ROAD PO BOX 14
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City | CHANGEWATER
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State | NJ
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Zip | 07831
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Country | US
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Telephone | 908-391-2548
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CARLA ERRICKSON
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Credential | MD
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Telephone | 908-391-2548
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 25MA066807000
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License Number State | NJ
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