Provider Demographics
NPI:1003958703
Name:SUNFLOWER MEDICAL ADULT DAY CARE
Entity type:Organization
Organization Name:SUNFLOWER MEDICAL ADULT DAY CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHEVAL
Authorized Official - Suffix:
Authorized Official - Credentials:CALA
Authorized Official - Phone:201-243-0666
Mailing Address - Street 1:300 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-3518
Mailing Address - Country:US
Mailing Address - Phone:201-243-0666
Mailing Address - Fax:201-243-1836
Practice Address - Street 1:300 BROADWAY
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3518
Practice Address - Country:US
Practice Address - Phone:201-243-0666
Practice Address - Fax:201-243-1836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ408210261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0020788Medicaid