Healthcare Provider Details

I. General information

NPI: 1083149975
Provider Name (Legal Business Name): MOM AND PAP'S HOME CARE AGENCY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2017
Last Update Date: 04/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 E PALISADE AVE 2ND FLOOR SUITE 206
ENGLEWOOD NJ
07631-2933
US

IV. Provider business mailing address

50 E PALISADE AVE 2ND FLOOR SUITE 206
ENGLEWOOD NJ
07631-2933
US

V. Phone/Fax

Practice location:
  • Phone: 201-567-3181
  • Fax: 201-567-1122
Mailing address:
  • Phone: 201-567-3181
  • Fax: 201-567-1122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHP0256500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberHP0256500
License Number StateNJ

VIII. Authorized Official

Name: ENA E FORBES
Title or Position: CEO
Credential: PRESIDENT
Phone: 201-567-3181