Provider Demographics
NPI:1437403102
Name:PARENT ASSOCIATE LLC
Entity Type:Organization
Organization Name:PARENT ASSOCIATE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DIAZ MATOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-345-4998
Mailing Address - Street 1:794 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07501-2409
Mailing Address - Country:US
Mailing Address - Phone:973-345-4998
Mailing Address - Fax:973-345-4998
Practice Address - Street 1:777 MADISON AVE
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07501-2409
Practice Address - Country:US
Practice Address - Phone:973-345-4998
Practice Address - Fax:973-345-4998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-02
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility