Healthcare Provider Details

I. General information

NPI: 1831570480
Provider Name (Legal Business Name): CENTURION ENTERPRISES DBA HOMEWELL CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2015
Last Update Date: 09/14/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 DYATT PL FLOOR 2
HACKENSACK NJ
07601-6004
US

IV. Provider business mailing address

15 DYATT PL FLOOR 2
HACKENSACK NJ
07601-6004
US

V. Phone/Fax

Practice location:
  • Phone: 201-487-9220
  • Fax: 201-487-9221
Mailing address:
  • Phone: 201-487-9220
  • Fax: 201-487-9221

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: LAURA COYLE
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 201-487-9220