Provider Demographics
NPI:1588081327
Name:CENTURY ADULT DAY HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:CENTURY ADULT DAY HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:BURT
Authorized Official - Middle Name:
Authorized Official - Last Name:LACIVITA
Authorized Official - Suffix:
Authorized Official - Credentials:MS OTR
Authorized Official - Phone:201-923-7533
Mailing Address - Street 1:141 S CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-2609
Mailing Address - Country:US
Mailing Address - Phone:973-325-0229
Mailing Address - Fax:
Practice Address - Street 1:16 LINDSLEY AVE
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-5310
Practice Address - Country:US
Practice Address - Phone:973-325-0229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-18
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care