Healthcare Provider Details

I. General information

NPI: 1174488639
Provider Name (Legal Business Name): MOMCARES GROUP HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 YOSKO DR # 1707
EDISON NJ
08817-2171
US

IV. Provider business mailing address

21 HIGH ACRE DR
HILLSBOROUGH NJ
08844-4717
US

V. Phone/Fax

Practice location:
  • Phone: 732-377-9889
  • Fax: 732-377-9606
Mailing address:
  • Phone: 603-233-6924
  • 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

VIII. Authorized Official

Name: JOAN SOI
Title or Position: PRESIDENT
Credential: BSN/RN
Phone: 603-233-6924