Healthcare Provider Details

I. General information

NPI: 1659242188
Provider Name (Legal Business Name): ANTOBRE HOME CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2025
Last Update Date: 09/17/2025
Certification Date: 09/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 MONTANA TRL
BROWNS MILLS NJ
08015-5701
US

IV. Provider business mailing address

307 MONTANA TRL
BROWNS MILLS NJ
08015-5701
US

V. Phone/Fax

Practice location:
  • Phone: 917-971-0451
  • Fax:
Mailing address:
  • Phone: 917-971-0451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. LEWIS OWUSU ANTOBRE
Title or Position: CEO
Credential:
Phone: 917-971-0451