Healthcare Provider Details

I. General information

NPI: 1790659464
Provider Name (Legal Business Name): SHS CENTRAL BERGEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2025
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 UNIVERSITY PLZ
HACKENSACK NJ
07601-6202
US

IV. Provider business mailing address

2 UNIVERSITY PLZ STE 100
HACKENSACK NJ
07601-6210
US

V. Phone/Fax

Practice location:
  • Phone: 201-255-0048
  • Fax:
Mailing address:
  • Phone: 201-255-0048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care 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: MR. IVAN JUSTO
Title or Position: CO-OWNER
Credential:
Phone: 914-490-9881