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General NPI Number Information
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NPI Number | 1770881559
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Entity Type | Organization
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Legal Business Name | SIGNATURE HEALTH CARE OF MONTCLAIR LLC
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Dates
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Enumeration Date | 03/03/2011
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Last Update Date | 05/10/2011
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Provider Practice Location Address
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Address Line | 110 GREENWOOD AVE
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City | MONTCLAIR
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State | NJ
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Zip | 07042-4010
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Country | US
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Telephone | 973-783-5589
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Fax | 973-783-3711
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Provider Business Mailing Address
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Address Line | 110 GREENWOOD AVE
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City | MONTCLAIR
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State | NJ
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Zip | 07042-4010
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Country | US
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Telephone | 973-783-5589
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Fax | 973-783-3711
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Authorized Official
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Title or Position | MANAGER
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Name | MICHAEL SANTANA
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Credential |
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Telephone | 973-783-5589
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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 | 308119
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License Number State | NJ
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