Provider Demographics
NPI:1750036661
Name:HOLY DOVE CHRISTIAN FELLOWSHIP
Entity Type:Organization
Organization Name:HOLY DOVE CHRISTIAN FELLOWSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:AYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-996-5575
Mailing Address - Street 1:915 STUYVESANT AVE
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-1116
Mailing Address - Country:US
Mailing Address - Phone:973-996-5575
Mailing Address - Fax:973-351-5443
Practice Address - Street 1:915 STUYVESANT AVE
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-1116
Practice Address - Country:US
Practice Address - Phone:973-996-5575
Practice Address - Fax:973-351-5443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care