Provider Demographics
NPI:1518475698
Name:HAITIAN AMERICAN ADULT RECREATION CENTER
Entity type:Organization
Organization Name:HAITIAN AMERICAN ADULT RECREATION CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGINE
Authorized Official - Suffix:
Authorized Official - Credentials:ASSISTANT DIETICIAN
Authorized Official - Phone:973-672-6200
Mailing Address - Street 1:84 SANFORD ST
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-1927
Mailing Address - Country:US
Mailing Address - Phone:973-672-6200
Mailing Address - Fax:973-672-6204
Practice Address - Street 1:84 SANFORD ST
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-1927
Practice Address - Country:US
Practice Address - Phone:973-672-6200
Practice Address - Fax:973-672-6204
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HAITIAN AMERICAN ADULT RESOURCES CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ555555555OtherUNITED