Provider Demographics
NPI:1740321157
Name:ATLANTIC ADULT DAY HEALTH CARE
Entity type:Organization
Organization Name:ATLANTIC ADULT DAY HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DERVECH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-383-3313
Mailing Address - Street 1:331 TILTON RD STE 2A
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-1248
Mailing Address - Country:US
Mailing Address - Phone:609-383-3313
Mailing Address - Fax:609-383-1600
Practice Address - Street 1:331 TILTON RD STE 2A
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1248
Practice Address - Country:US
Practice Address - Phone:609-383-3313
Practice Address - Fax:609-383-1600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNE6M6S302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8923001Medicaid