Healthcare Provider Details

I. General information

NPI: 1538481676
Provider Name (Legal Business Name): HOME HEALTH ALLIANCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2010
Last Update Date: 02/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 S WASHINGTON AVE
BERGENFIELD NJ
07621-4312
US

IV. Provider business mailing address

380 S WASHINGTON AVE
BERGENFIELD NJ
07621-4312
US

V. Phone/Fax

Practice location:
  • Phone: 201-385-3448
  • Fax:
Mailing address:
  • Phone: 201-385-3448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0400X
TaxonomyRehabilitation Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MR. ENRIQUE ENRIQUEZ
Title or Position: CPA
Credential: CPA
Phone: 201-385-3448