Organization
PROVIDENCE PEDIATRIC MEDICAL DAYCARE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LEEANNA ROMAN (PRESIDENT)
(856) 753-7763
Entity
Organization
Contact information
Practice address
1000 ATLANTIC AVE, CAMDEN D, 2ND FLOOR, CAMDEN, NJ 08104-1132
(856) 338-0900
(856) 338-0029
Mailing address
411 COMMERCE LN, WEST BERLIN, NJ 08091-9254
(856) 753-7763
(856) 753-7714
Taxonomy
Speciality
Code
Description
License number
State
261QM3000X
Medically Fragile Infants and Children Day Care
Primary
158222
NJ
Other
Enumeration date
01/16/2007
Last updated
06/03/2008
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