Healthcare Provider Details

I. General information

NPI: 1457586000
Provider Name (Legal Business Name): RAF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2009
Last Update Date: 05/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17-15 MAPLE AVE SUITE 101L
FAIR LAWN NJ
07410-1552
US

IV. Provider business mailing address

17-15 MAPLE AVE SUITE 101L
FAIR LAWN NJ
07410-1552
US

V. Phone/Fax

Practice location:
  • Phone: 201-773-4900
  • Fax: 201-773-4898
Mailing address:
  • Phone: 201-773-4900
  • Fax: 201-773-4898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberHP0128000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberHP0128000
License Number StateNJ

VIII. Authorized Official

Name: MR. RICHARD A FRACARO
Title or Position: PRESIDENT
Credential:
Phone: 201-988-2435