MEDICARE: IDEAL HOME HEALTHCARE

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	:	1891327656
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IDEAL HOME HEALTHCARE

Provider Business Mailing Address
First Line	:	133 WENTZ AVE
Second Line	:
City	:	WOODBURY HTS
State	:	NJ
Zip	:	08097
Country	:	US
Telephone Number	:	215-696-2300
Fax Number	:

Provider Business Practice Location Address
First Line	:	133 WENTZ AVE
Second Line	:
City	:	WOODBURY HTS
State	:	NJ
Zip	:	08097
Country	:	US
Telephone Number	:	215-696-2300
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	KASEIM EZELL
Credential	:
Telephone Number	:	215-696-2300

Provider Enumeration Date	:	02/10/2020
Last Update Date	:	02/10/2020

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