Healthcare Provider Details

I. General information

NPI: 1134984552
Provider Name (Legal Business Name): CMFORT CARE AT HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2024
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 BENFORD LN
EDGEWATER PARK NJ
08010-1750
US

IV. Provider business mailing address

103 BENFORD LN
EDGEWATER PARK NJ
08010-1750
US

V. Phone/Fax

Practice location:
  • Phone: 609-643-1177
  • Fax:
Mailing address:
  • Phone: 609-643-1177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. LATESHIA R DELEE
Title or Position: LPN
Credential: LPN
Phone: 609-643-1177