Provider Demographics
NPI:1972645034
Name:FIVE STAR ADULT MEDICAL DAY CARE CENTER LLC
Entity Type:Organization
Organization Name:FIVE STAR ADULT MEDICAL DAY CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:SVETLANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARYASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-486-5750
Mailing Address - Street 1:1201 DEERFIELD TER
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-5523
Mailing Address - Country:US
Mailing Address - Phone:908-486-5750
Mailing Address - Fax:908-486-3325
Practice Address - Street 1:1201 DEERFIELD TER
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-5523
Practice Address - Country:US
Practice Address - Phone:908-486-5750
Practice Address - Fax:908-486-3325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ908112261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0034878Medicaid