Healthcare Provider Details

I. General information

NPI: 1578360269
Provider Name (Legal Business Name): STAND OUT HOME CARE OF NJ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2025
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 HACKENSACK AVE STE 200
HACKENSACK NJ
07601-6451
US

IV. Provider business mailing address

PO BOX 40520
BROOKLYN NY
11204-0520
US

V. Phone/Fax

Practice location:
  • Phone: 201-582-4000
  • Fax: 201-582-4040
Mailing address:
  • Phone: 201-582-4000
  • Fax: 201-582-4040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SHAWNYA KING
Title or Position: CONTRACTING REP
Credential:
Phone: 201-582-4000