Provider Demographics
NPI:1548620701
Name:WISHING WELL ADULT DAY HEALTH CARE, LLC
Entity type:Organization
Organization Name:WISHING WELL ADULT DAY HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:O'CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:732-856-3778
Mailing Address - Street 1:3450 PRINCETON PIKE STE 120
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-1206
Mailing Address - Country:US
Mailing Address - Phone:732-242-9741
Mailing Address - Fax:732-242-9741
Practice Address - Street 1:3450 PRINCETON PIKE STE 120
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-1206
Practice Address - Country:US
Practice Address - Phone:732-242-9741
Practice Address - Fax:732-242-9741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-02
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ11012313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility