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
35 S ANNAPOLIS AVE, ATLANTIC CITY, NJ 08401-5927
(609) 345-2340
(609) 345-3021
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
018200
NJ
Other
Enumeration date
06/03/2008
Last updated
06/03/2008
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