MEDICARE: WILEY CHRISTIAN ADULT DAY SERVICES, INC.

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	261QA0600X	Adult Day Care Clinic/Center	080473	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	:	1528059656
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILEY CHRISTIAN ADULT DAY SERVICES, INC.

Provider Business Mailing Address
First Line	:	99 E MAIN ST
Second Line	:
City	:	MARLTON
State	:	NJ
Zip	:	08053-2122
Country	:	US
Telephone Number	:	856-983-0411
Fax Number	:	856-985-4655

Provider Business Practice Location Address
First Line	:	6103 WESTFIELD AVE
Second Line	:
City	:	PENNSAUKEN
State	:	NJ
Zip	:	08110-1754
Country	:	US
Telephone Number	:	856-486-9737
Fax Number	:	856-486-1098

Authorized Official
Title or Position	:	CEO
Name	:	MR. GARY F GILMORE
Credential	:
Telephone Number	:	856-983-0411

Provider Enumeration Date	:	10/28/2005
Last Update Date	:	08/22/2020

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