Healthcare Provider Details

I. General information

NPI: 1558296772
Provider Name (Legal Business Name): JC HOME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1139 E JERSEY ST
ELIZABETH NJ
07201-2473
US

IV. Provider business mailing address

1139 E JERSEY ST
ELIZABETH NJ
07201-2473
US

V. Phone/Fax

Practice location:
  • Phone: 551-396-0315
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: JOSE I CORREA TRIANA
Title or Position: OWNER
Credential:
Phone: 908-906-6903