MEDICARE: CONLIFFE HOME CARE LLC DBA EXECUTIVE CARE

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	HP1099600	NJ

General Provider Information

NPI Number	:	1407357379
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONLIFFE HOME CARE LLC DBA EXECUTIVE CARE

Provider Business Mailing Address
First Line	:	1807 SPRINGDALE RD STE C
Second Line	:
City	:	CHERRY HILL
State	:	NJ
Zip	:	08003-6000
Country	:	US
Telephone Number	:	856-424-5555
Fax Number	:

Provider Business Practice Location Address
First Line	:	1807 SPRINGDALE RD STE C
Second Line	:
City	:	CHERRY HILL
State	:	NJ
Zip	:	08003-6000
Country	:	US
Telephone Number	:	856-424-5555
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KARA CONLIFFE
Credential	:	MD
Telephone Number	:	856-424-5555

Provider Enumeration Date	:	02/26/2018
Last Update Date	:	02/26/2018

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