MEDICARE: ST. MONICA HEALTHCARE AGENCY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	HP0203300	NJ
2	251F00000X	Home Infusion Agency	HP0203300	NJ
3	253Z00000X	In Home Supportive Care Agency	HP0203300	NJ
4	251J00000X	Nursing Care Agency	HP0203300	NJ

General Provider Information

NPI Number	:	1326571506
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. MONICA HEALTHCARE AGENCY, LLC

Provider Business Mailing Address
First Line	:	20 PROSPECT PL
Second Line	:	2ND FLOOR
City	:	WEST ORANGE
State	:	NJ
Zip	:	07052-5608
Country	:	US
Telephone Number	:	973-736-1383
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 PROSPECT PL
Second Line	:	2ND FLOOR
City	:	WEST ORANGE
State	:	NJ
Zip	:	07052-5608
Country	:	US
Telephone Number	:	973-736-1383
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER, CEO, REGISTERED NURSE
Name	:	MS. BENEDICTA CHINYERE AKPAHU
Credential	:
Telephone Number	:	973-736-1383

Provider Enumeration Date	:	04/05/2017
Last Update Date	:	04/05/2017

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