Healthcare Provider Details

I. General information

NPI: 1396388617
Provider Name (Legal Business Name): MARY'S LOVING CARE STAFFING,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2019
Last Update Date: 10/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 MAIN ST STE 303
HACKENSACK NJ
07601-7100
US

IV. Provider business mailing address

85 MAIN ST STE 303
HACKENSACK NJ
07601-7100
US

V. Phone/Fax

Practice location:
  • Phone: 201-470-5355
  • Fax: 201-488-0088
Mailing address:
  • Phone: 201-470-5355
  • Fax: 201-488-0088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
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: MRS. CYNTHIA DENISE HILL
Title or Position: C.E.O/ADMINISTRATOR
Credential:
Phone: 201-470-5355