Organization
SHADY REST RESIDENTIAL FACILITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIOUN YOUNG (OWNER)
(856) 668-6610
Entity
Organization
Contact information
Practice address
343 TEXAS AVE, MT LAUREL, NJ 08054-0805
(856) 668-6610
(856) 668-6610
Mailing address
343 TEXAS AVE, MOUNT LAUREL, NJ 08054-3510
(856) 668-6610
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Enumeration date
12/05/2017
Last updated
12/05/2017
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