Organization
THE WELL BALANCED SENIOR PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHELLY DENISE LARKINS (EXECUTIVE DIRECTOR)
(908) 296-5258
Entity
Organization
Contact information
Practice address
111 SOUTH MUNN AVE, SUITE 2A, EAST ORANGE, NJ 07018
(908) 296-5258
(973) 732-0460
Mailing address
111 SOUTH MUNN AVE, SUITE 2A, EAST ORANGE, NJ 07018
(908) 296-5258
(973) 732-0460
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
0400239766
NJ
251E00000X
Home Health Agency
HP0135400
NJ
261QC1500X
Community Health Clinic/Center
0400239766
NJ
Other
Enumeration date
07/10/2008
Last updated
11/23/2009
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