Healthcare Provider Details

I. General information

NPI: 1386002541
Provider Name (Legal Business Name): BE WHOLE INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2016
Last Update Date: 02/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 CENTRAL AVE
HACKENSACK NJ
07601-2428
US

IV. Provider business mailing address

75 PALSA AVE
ELMWOOD PARK NJ
07407-1213
US

V. Phone/Fax

Practice location:
  • Phone: 201-490-7792
  • Fax:
Mailing address:
  • Phone: 201-773-6328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. SEDRICK D SIMS
Title or Position: VICE PRESIDENT
Credential:
Phone: 201-773-6328