Provider Demographics
NPI:1902945140
Name:NORTH BERGEN SENIORS COUNT LLC
Entity Type:Organization
Organization Name:NORTH BERGEN SENIORS COUNT LLC
Other - Org Name:RISE AND SHINE ADULT MEDICAL DAY CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLYNES
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:201-869-4443
Mailing Address - Street 1:6201 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-3469
Mailing Address - Country:US
Mailing Address - Phone:201-869-4443
Mailing Address - Fax:201-869-0814
Practice Address - Street 1:6201 GRAND AVE
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-3469
Practice Address - Country:US
Practice Address - Phone:201-869-4443
Practice Address - Fax:201-869-0814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJL9NOH7261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care