Provider Demographics
NPI:1134284771
Name:WINDSOR GARDENS ADULT DAY CARE
Entity Type:Organization
Organization Name:WINDSOR GARDENS ADULT DAY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SHIMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:IDELS
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:973-677-0111
Mailing Address - Street 1:140 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07017-5248
Mailing Address - Country:US
Mailing Address - Phone:973-677-0111
Mailing Address - Fax:973-677-0096
Practice Address - Street 1:140 PARK AVE
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07017-5248
Practice Address - Country:US
Practice Address - Phone:973-677-0111
Practice Address - Fax:973-677-0096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ308118311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0076171Medicaid