Provider Demographics
NPI:1063681179
Name:SECOND INNING1 ADULT DAY CARE CENTER
Entity Type:Organization
Organization Name:SECOND INNING1 ADULT DAY CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAGAT
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:190-832-9555
Mailing Address - Street 1:155 ALGONQUIN PKWY
Mailing Address - Street 2:
Mailing Address - City:WHIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07981-1601
Mailing Address - Country:US
Mailing Address - Phone:190-832-9555
Mailing Address - Fax:173-263-5209
Practice Address - Street 1:155 ALGONQUIN PKWY
Practice Address - Street 2:
Practice Address - City:WHIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07981-1601
Practice Address - Country:US
Practice Address - Phone:190-832-9555
Practice Address - Fax:173-263-5209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJIN PROCESS261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJIN PROCESSMedicaid