Provider Demographics
NPI:1245546621
Name:GRACELAND ADULT MEDICAL DAY CARE,INC
Entity type:Organization
Organization Name:GRACELAND ADULT MEDICAL DAY CARE,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAKREVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-902-5902
Mailing Address - Street 1:316 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08861-4108
Mailing Address - Country:US
Mailing Address - Phone:732-347-0074
Mailing Address - Fax:
Practice Address - Street 1:316 MADISON AVE
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-4108
Practice Address - Country:US
Practice Address - Phone:732-347-0074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-24
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care