Healthcare Provider Details

I. General information

NPI: 1205310018
Provider Name (Legal Business Name): CITADEL AT HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2018
Last Update Date: 03/28/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 GLENWOOD AVE STE 412
EAST ORANGE NJ
07017-1041
US

IV. Provider business mailing address

1000 GATES AVE STE 4
BROOKLYN NY
11221-6296
US

V. Phone/Fax

Practice location:
  • Phone: 973-965-0366
  • Fax: 973-965-0367
Mailing address:
  • Phone: 917-805-0702
  • Fax: 718-280-1050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: GREGORY THOMAS CRAWFORD
Title or Position: VICE PRESIDENT OF OPERATIONS
Credential:
Phone: 973-965-0366