Healthcare Provider Details

I. General information

NPI: 1902094220
Provider Name (Legal Business Name): BERGEN HOME CARE AND NURSING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 11/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 ESSEX STREET
HACKENSACK NJ
07601
US

IV. Provider business mailing address

136 ESSEX STREET
HACKENSACK NJ
07601
US

V. Phone/Fax

Practice location:
  • Phone: 201-342-3402
  • Fax: 201-342-3405
Mailing address:
  • Phone: 201-342-3402
  • Fax: 201-342-3405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberHP0022500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHP0022500
License Number StateNJ

VII. Legacy identifiers

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

# 1
Identifier0149772
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name: MR. PROSPER K BONUEDIE
Title or Position: PRESIDENT
Credential: RN.,BSN
Phone: 201-342-3402