Provider Demographics
NPI:1376766493
Name:SENIOR CARE & ACTIVITIES CENTER
Entity Type:Organization
Organization Name:SENIOR CARE & ACTIVITIES CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:JENNY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-783-5589
Mailing Address - Street 1:110 GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-4010
Mailing Address - Country:US
Mailing Address - Phone:973-783-5589
Mailing Address - Fax:973-783-3711
Practice Address - Street 1:110 GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-4010
Practice Address - Country:US
Practice Address - Phone:973-783-5589
Practice Address - Fax:973-783-3711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ308119261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0073016Medicaid