Organization
PPMD WEST BERLIN 1ST FLOOR
Active
Parent organization
PROVIDENCE PEDIATRIC MEDICAL DAYCARE INC.
Other names
Providence Pediatric Medical DayCare Inc.
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROVIDENCE PEDIATRIC MEDICAL DAYCARE INC.
Authorized official
MRS. LEEANNA ROMAN-LOZADA (PRECIDENT / CEO)
(856) 753-7763
Entity
Organization
Contact information
Practice address
411 COMMERCE LN, FIRST FLOOR, WEST BERLIN, NJ 08091-9254
(856) 753-7935
(856) 753-7714
Mailing address
411 COMMERCE LN, WEST BERLIN, NJ 08091-9254
(856) 753-7763
(856) 753-7714
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
04012
NJ
Other
Enumeration date
12/09/2014
Last updated
12/09/2014
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