MEDICARE: PROVIDENCE CARE, LLC

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		NJ

General Provider Information

NPI Number	:	1699953406
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROVIDENCE CARE, LLC

Provider Business Mailing Address
First Line	:	80 W UPPER FERRY RD
Second Line	:
City	:	EWING
State	:	NJ
Zip	:	08628-2736
Country	:	US
Telephone Number	:	732-942-6400
Fax Number	:

Provider Business Practice Location Address
First Line	:	80 W UPPER FERRY RD
Second Line	:
City	:	EWING
State	:	NJ
Zip	:	08628-2736
Country	:	US
Telephone Number	:	732-942-6400
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. SIMON FRIDMANN
Credential	:
Telephone Number	:	732-942-6400

Provider Enumeration Date	:	02/04/2008
Last Update Date	:	02/04/2008

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Directions to “PROVIDENCE CARE, LLC ” Practice Location

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