Provider Demographics
NPI:1427647569
Name:2ND HOME ADC LLC
Entity type:Organization
Organization Name:2ND HOME ADC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FRUCHTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-672-2621
Mailing Address - Street 1:25 E SALEM ST STE 500
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-7400
Mailing Address - Country:US
Mailing Address - Phone:516-672-2621
Mailing Address - Fax:
Practice Address - Street 1:130 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-3821
Practice Address - Country:US
Practice Address - Phone:516-672-2621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care