Provider Demographics
NPI:1417096157
Name:PASSAIC COUNTY ELKS ADULT TRAINING CENTER
Entity Type:Organization
Organization Name:PASSAIC COUNTY ELKS ADULT TRAINING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHVALSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-478-6655
Mailing Address - Street 1:600 US HIGHWAY 46
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-1503
Mailing Address - Country:US
Mailing Address - Phone:973-478-6655
Mailing Address - Fax:
Practice Address - Street 1:600 US HIGHWAY 46
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-1503
Practice Address - Country:US
Practice Address - Phone:973-478-6655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care