Provider Demographics
NPI:1447680020
Name:EPIC MEDICAL DAYCARE
Entity type:Organization
Organization Name:EPIC MEDICAL DAYCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-342-6904
Mailing Address - Street 1:39 FOREST ST
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3550
Mailing Address - Country:US
Mailing Address - Phone:973-342-6904
Mailing Address - Fax:
Practice Address - Street 1:39 FOREST ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3550
Practice Address - Country:US
Practice Address - Phone:973-342-6904
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-19
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJR074780385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child