Provider Demographics
NPI:1740601376
Name:ALLIANCE ADULT MEDICAL DAY CARE SERVICES, LLC
Entity Type:Organization
Organization Name:ALLIANCE ADULT MEDICAL DAY CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JUPJEET
Authorized Official - Middle Name:
Authorized Official - Last Name:KAUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:862-591-7127
Mailing Address - Street 1:607 S WHITE HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:AUDUBON
Mailing Address - State:NJ
Mailing Address - Zip Code:08106-1314
Mailing Address - Country:US
Mailing Address - Phone:856-617-6396
Mailing Address - Fax:856-617-6026
Practice Address - Street 1:607 S WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:AUDUBON
Practice Address - State:NJ
Practice Address - Zip Code:08106-1314
Practice Address - Country:US
Practice Address - Phone:856-617-6396
Practice Address - Fax:856-617-6026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-28
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ04008311ZA0620X
NJ311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0404900Medicaid