MEDICARE: RISING SUN HOMECARE

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

General Provider Information

NPI Number	:	1376210716
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RISING SUN HOMECARE

Provider Business Mailing Address
First Line	:	100 HIGH ST STE 305
Second Line	:
City	:	MOUNT HOLLY
State	:	NJ
Zip	:	08060-1458
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 HIGH ST STE 305
Second Line	:
City	:	MOUNT HOLLY
State	:	NJ
Zip	:	08060-1458
Country	:	US
Telephone Number	:	609-456-1758
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF NURSING
Name	:	MR. CHINEDU AGADA
Credential	:
Telephone Number	:	609-456-1758

Provider Enumeration Date	:	08/24/2021
Last Update Date	:	08/24/2021

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