Healthcare Provider Details

I. General information

NPI: 1184392193
Provider Name (Legal Business Name): SHALANDA HOME CARE SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2021
Last Update Date: 10/27/2021
Certification Date: 10/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

197 ROUTE 18 STE 30
EAST BRUNSWICK NJ
08816-1440
US

IV. Provider business mailing address

197 ROUTE 18 STE 30
EAST BRUNSWICK NJ
08816-1440
US

V. Phone/Fax

Practice location:
  • Phone: 201-471-5403
  • Fax:
Mailing address:
  • Phone: 201-471-5403
  • 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 Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHALANDA SMART
Title or Position: CEO
Credential:
Phone: 201-471-5403