Provider Demographics
NPI:1508214099
Name:DIAMOND YEARS ADULT MEDICAL DAY CARE CENTER LLC
Entity Type:Organization
Organization Name:DIAMOND YEARS ADULT MEDICAL DAY CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EUGENA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-942-4111
Mailing Address - Street 1:360 WEST CLINTON STREET
Mailing Address - Street 2:
Mailing Address - City:HALEDON
Mailing Address - State:NJ
Mailing Address - Zip Code:07508
Mailing Address - Country:US
Mailing Address - Phone:973-942-4111
Mailing Address - Fax:973-942-0111
Practice Address - Street 1:360 WEST CLINTON STREET
Practice Address - Street 2:
Practice Address - City:HALEDON
Practice Address - State:NJ
Practice Address - Zip Code:07508
Practice Address - Country:US
Practice Address - Phone:973-942-4111
Practice Address - Fax:973-942-0111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care