Provider Demographics
NPI:1366821241
Name:ACTIVE DAY ADULT SOCIAL SERVICES
Entity Type:Organization
Organization Name:ACTIVE DAY ADULT SOCIAL SERVICES
Other - Org Name:ACTIVE DAY ADULT SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TATIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LARINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-851-6640
Mailing Address - Street 1:20 JACKSON ST STE 1A
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2476
Mailing Address - Country:US
Mailing Address - Phone:732-845-3332
Mailing Address - Fax:732-845-3339
Practice Address - Street 1:20 JACKSON ST STE 1A
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2476
Practice Address - Country:US
Practice Address - Phone:732-845-3332
Practice Address - Fax:732-845-3339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-25
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ251C00000X
NJ13008261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services