=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922139328
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOPEWELL MEDICAL ADULT DAY CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/08/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 290 CHESTNUT ST
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07105-1559
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-817-8500
-----------------------------------------------------
Fax | 973-817-8509
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 290 CHESTNUT ST
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07105-1559
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-817-8500
-----------------------------------------------------
Fax | 973-817-8509
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO ADMINISTRATOR
-----------------------------------------------------
Name | MS. MARY WILLIAMS CUDJOE
-----------------------------------------------------
Credential | CALA
-----------------------------------------------------
Telephone | 973-817-8500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number | 9069801
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------