Provider Demographics
NPI:1235313446
Name:PEDIATRIC AND ADULT REHABILITATION CENTER, LLC
Entity Type:Organization
Organization Name:PEDIATRIC AND ADULT REHABILITATION CENTER, LLC
Other - Org Name:PARC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:ANDERSON
Authorized Official - Last Name:BALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:M S, CCC-SLP
Authorized Official - Phone:732-560-7500
Mailing Address - Street 1:370 CAMPUS DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1128
Mailing Address - Country:US
Mailing Address - Phone:732-560-7500
Mailing Address - Fax:732-289-6067
Practice Address - Street 1:370 CAMPUS DR
Practice Address - Street 2:SUITE 101
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-1128
Practice Address - Country:US
Practice Address - Phone:732-560-7500
Practice Address - Fax:732-289-6067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty