Healthcare Provider Details

I. General information

NPI: 1669381075
Provider Name (Legal Business Name): WESTSIDE HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 FRIES MILL RD STE 101
BLACKWOOD NJ
08012-2056
US

IV. Provider business mailing address

151 FRIES MILL RD STE 101
BLACKWOOD NJ
08012-2056
US

V. Phone/Fax

Practice location:
  • Phone: 201-377-0880
  • Fax:
Mailing address:
  • Phone: 201-377-0880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SEAN R STUMBO
Title or Position: OWNER
Credential:
Phone: 201-377-0880