Provider Demographics
NPI:1477761955
Name:BUCKINGHAM ADULT MEDICAL DAY CARE CENTER LLC
Entity type:Organization
Organization Name:BUCKINGHAM ADULT MEDICAL DAY CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CRISTIMINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:BACSW
Authorized Official - Phone:973-907-3875
Mailing Address - Street 1:316 N 6TH ST
Mailing Address - Street 2:PROSPECT PARK
Mailing Address - City:PROSPECT PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07508-2122
Mailing Address - Country:US
Mailing Address - Phone:973-904-3875
Mailing Address - Fax:973-904-1477
Practice Address - Street 1:316 N 6TH ST
Practice Address - Street 2:PROSPECT PARK
Practice Address - City:PROSPECT PARK
Practice Address - State:NJ
Practice Address - Zip Code:07508-2122
Practice Address - Country:US
Practice Address - Phone:973-904-3875
Practice Address - Fax:973-904-1477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ708113261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0124834Medicaid