Provider Demographics
NPI:1851721708
Name:VICTORIAN GARDEN ADULT DAY CENTER
Entity Type:Organization
Organization Name:VICTORIAN GARDEN ADULT DAY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:MARYANN
Authorized Official - Last Name:FLEMMING
Authorized Official - Suffix:
Authorized Official - Credentials:CDP
Authorized Official - Phone:973-635-2266
Mailing Address - Street 1:353 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-2229
Mailing Address - Country:US
Mailing Address - Phone:973-635-2266
Mailing Address - Fax:973-635-0108
Practice Address - Street 1:353 MAIN ST
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928-2229
Practice Address - Country:US
Practice Address - Phone:973-635-2266
Practice Address - Fax:973-635-0108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care