Provider Demographics
NPI:1952562183
Name:CALVARY BAPTIST ADULT MEDICAL DAY CARE
Entity Type:Organization
Organization Name:CALVARY BAPTIST ADULT MEDICAL DAY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:CALA
Authorized Official - Phone:973-977-9100
Mailing Address - Street 1:575 E 18TH ST
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07514-2624
Mailing Address - Country:US
Mailing Address - Phone:973-977-9100
Mailing Address - Fax:973-977-2023
Practice Address - Street 1:575 E 18TH ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07514-2624
Practice Address - Country:US
Practice Address - Phone:973-977-9100
Practice Address - Fax:973-977-2023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ708117261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0147559Medicaid