Healthcare Provider Details

I. General information

NPI: 1013811181
Provider Name (Legal Business Name): JAXCE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 MYRTLE AVE APT B5
IRVINGTON NJ
07111-3370
US

IV. Provider business mailing address

94 MYRTLE AVE APT B5
IRVINGTON NJ
07111-3370
US

V. Phone/Fax

Practice location:
  • Phone: 862-704-3506
  • Fax:
Mailing address:
  • Phone: 862-704-3506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. JULIUS OSAYANDE OSIFO
Title or Position: OWNER
Credential:
Phone: 862-704-3506