Healthcare Provider Details

I. General information

NPI: 1588844195
Provider Name (Legal Business Name): ADDUS HEALTHCARE (NEW JERSEY), INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2007
Last Update Date: 06/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 JAMES ST UNIT 6A
BLOOMFIELD NJ
07003-3656
US

IV. Provider business mailing address

17 JAMES ST UNIT 6A
BLOOMFIELD NJ
07003-3656
US

V. Phone/Fax

Practice location:
  • Phone: 973-743-4200
  • Fax: 973-742-4220
Mailing address:
  • Phone: 973-743-4200
  • Fax: 973-742-4220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHP0097800
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. DIANE KUMARICH
Title or Position: NATIONAL CONTRACTS
Credential: RN, MS, MBA
Phone: 847-303-5300