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General NPI Number Information
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NPI Number | 1710480355
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Entity Type | Organization
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Legal Business Name | HERITAGE ADULT ENRICHMENT CENTER, LLC
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Dates
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Enumeration Date | 03/09/2018
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Last Update Date | 03/09/2018
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Provider Practice Location Address
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Address Line | 440 WASHINGTON ST
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City | ORANGE
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State | NJ
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Zip | 07050-1932
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Country | US
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Telephone | 973-677-2273
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Fax | 862-233-6450
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Provider Business Mailing Address
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Address Line | 335 S PINE AVE
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City | MAPLE SHADE
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State | NJ
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Zip | 08052-1806
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Country | US
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Telephone | 856-207-3364
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Fax |
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MRS. RENE MARIE MALTS
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Credential | RN
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Telephone | 973-677-2273
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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 | 07025
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License Number State | NJ
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