Healthcare Provider Details

I. General information

NPI: 1376317123
Provider Name (Legal Business Name): COMMUNITY & HOME INDEPENDENCE PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2023
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 AKRON AVE
HADDON TOWNSHIP NJ
08108-2408
US

IV. Provider business mailing address

106 AKRON AVE
HADDON TOWNSHIP NJ
08108-2408
US

V. Phone/Fax

Practice location:
  • Phone: 856-316-8624
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XE0001X
TaxonomyEnvironmental Modification Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: JILLIAN BUCOLO
Title or Position: OWNER, OCCUPATIONAL THERAPIST
Credential:
Phone: 856-316-8624