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General NPI Number Information
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NPI Number | 1881721231
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Entity Type | Organization
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Legal Business Name | THE CLUB AT KENSINGTON COURT
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 864 SHREWSBURY AVE
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City | TINTON FALLS
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State | NJ
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Zip | 07724-3074
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Country | US
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Telephone | 732-542-8700
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Fax | 732-542-6447
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Provider Business Mailing Address
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Address Line | 864 SHREWSBURY AVE
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City | TINTON FALLS
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State | NJ
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Zip | 07724-3074
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Country | US
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Telephone | 732-542-8700
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Fax | 732-542-6447
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JOHN WOZNISKY
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Credential |
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Telephone | 732-542-8700
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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 | I87QXS
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License Number State | NJ
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