Healthcare Provider Details

I. General information

NPI: 1750005633
Provider Name (Legal Business Name): TESSANEKA HILL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1676 N OLDEN AVE STE 3
EWING NJ
08638-3210
US

IV. Provider business mailing address

1676 N OLDEN AVE STE 3
EWING NJ
08638-3210
US

V. Phone/Fax

Practice location:
  • Phone: 609-250-2920
  • Fax: 609-250-2919
Mailing address:
  • Phone: 609-250-2920
  • Fax: 609-250-2919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. DWANE EVERETT
Title or Position: COO
Credential:
Phone: 609-977-7093