Healthcare Provider Details

I. General information

NPI: 1891173860
Provider Name (Legal Business Name): ACCESSIBLE HOMES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 05/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 GRASSMERE ST
LAKEWOOD NJ
08701-5262
US

IV. Provider business mailing address

11 GRASSMERE ST
LAKEWOOD NJ
08701-5262
US

V. Phone/Fax

Practice location:
  • Phone: 732-886-5800
  • Fax:
Mailing address:
  • Phone: 732-886-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number13VH04214400
License Number StateNJ

VIII. Authorized Official

Name: LEON FISCHER
Title or Position: MEMBER
Credential:
Phone: 732-886-5800