MEDICARE: WINDSOR GARDENS ADULT DAY CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311ZA0620X	Adult Care Home Facility	308118	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134284771
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WINDSOR GARDENS ADULT DAY CARE

Provider Business Mailing Address
First Line	:	140 PARK AVE
Second Line	:
City	:	EAST ORANGE
State	:	NJ
Zip	:	07017-5248
Country	:	US
Telephone Number	:	973-677-0111
Fax Number	:	973-677-0096

Provider Business Practice Location Address
First Line	:	140 PARK AVE
Second Line	:
City	:	EAST ORANGE
State	:	NJ
Zip	:	07017-5248
Country	:	US
Telephone Number	:	973-677-0111
Fax Number	:	973-677-0096

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. SHIMMY IDELS
Credential	:	L.N.H.A.
Telephone Number	:	973-677-0111

Provider Enumeration Date	:	12/26/2006
Last Update Date	:	08/22/2020

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