Healthcare Provider Details

I. General information

NPI: 1669376018
Provider Name (Legal Business Name): LIFECARE SUPPORT HOMECARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 CLIFFORD ST APT 2
EAST ORANGE NJ
07018-1977
US

IV. Provider business mailing address

44 CLIFFORD ST APT 2
EAST ORANGE NJ
07018-1977
US

V. Phone/Fax

Practice location:
  • Phone: 530-812-7204
  • Fax:
Mailing address:
  • Phone: 530-812-7204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. JANET JOAN SANDY
Title or Position: CEO
Credential: HOME HEALTH SERVICES
Phone: 530-812-7204