Provider Demographics
NPI:1841318482
Name:SWEET HOME ADULT MEDICAL DAY CARE INC
Entity type:Organization
Organization Name:SWEET HOME ADULT MEDICAL DAY CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAKREVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-478-4200
Mailing Address - Street 1:45 E MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-2381
Mailing Address - Country:US
Mailing Address - Phone:973-478-4200
Mailing Address - Fax:973-478-3331
Practice Address - Street 1:45 E MADISON AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-2381
Practice Address - Country:US
Practice Address - Phone:973-478-4200
Practice Address - Fax:973-478-3331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ708115311ZA0620X
261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0011312Medicaid