Provider Demographics
NPI:1457515207
Name:THE WELL BALANCED SENIOR PROGRAM
Entity Type:Organization
Organization Name:THE WELL BALANCED SENIOR PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:LARKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-296-5258
Mailing Address - Street 1:111 SOUTH MUNN AVE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018
Mailing Address - Country:US
Mailing Address - Phone:908-296-5258
Mailing Address - Fax:973-732-0460
Practice Address - Street 1:111 SOUTH MUNN AVE
Practice Address - Street 2:SUITE 2A
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018
Practice Address - Country:US
Practice Address - Phone:908-296-5258
Practice Address - Fax:973-732-0460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0400239766172V00000X, 261QC1500X
NJHP0135400251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity HealthGroup - Multi-Specialty