Healthcare Provider Details

I. General information

NPI: 1841859840
Provider Name (Legal Business Name): CITADEL AT HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 07/14/2020
Certification Date: 07/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 ROUTE 9 S STE 1000
FREEHOLD NJ
07728-1383
US

IV. Provider business mailing address

1000 GATES AVE STE 4
BROOKLYN NY
11221-6296
US

V. Phone/Fax

Practice location:
  • Phone: 973-412-3400
  • Fax: 973-412-3401
Mailing address:
  • Phone: 917-805-0702
  • Fax: 973-965-0367

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: CAROL SHAFIR
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 917-805-0702