1235313446 NPI number — PEDIATRIC AND ADULT REHABILITATION CENTER, LLC

Table of content: (NPI 1235313446)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235313446 NPI number — PEDIATRIC AND ADULT REHABILITATION CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEDIATRIC AND ADULT REHABILITATION CENTER, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PARC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235313446
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
370 CAMPUS DR
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
SOMERSET
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08873-1128
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-560-7500
Provider Business Mailing Address Fax Number:
732-289-6067

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
370 CAMPUS DR
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
SOMERSET
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08873-1128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-560-7500
Provider Business Practice Location Address Fax Number:
732-289-6067
Provider Enumeration Date:
12/24/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BALLARD
Authorized Official First Name:
GLORIA
Authorized Official Middle Name:
ANDERSON
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
732-560-7500

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)