Healthcare Provider Details

I. General information

NPI: 1376949180
Provider Name (Legal Business Name): HDA OPCO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2014
Last Update Date: 12/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 BROADWAY
BAYONNE NJ
07002-3522
US

IV. Provider business mailing address

325 BROADWAY
BAYONNE NJ
07002-3522
US

V. Phone/Fax

Practice location:
  • Phone: 201-339-2500
  • Fax:
Mailing address:
  • Phone: 201-339-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JOEL ZUPNICK
Title or Position: MEMBER
Credential:
Phone: 718-232-2583