Healthcare Provider Details

I. General information

NPI: 1720783608
Provider Name (Legal Business Name): NEW JERSEY DIRECT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2023
Last Update Date: 04/03/2023
Certification Date: 04/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 HARBOURTOWN BLVD
LITTLE EGG HARBOR TWP NJ
08087-3309
US

IV. Provider business mailing address

329 HARBOURTOWN BLVD
LITTLE EGG HARBOR TWP NJ
08087-3309
US

V. Phone/Fax

Practice location:
  • Phone: 609-905-5340
  • Fax:
Mailing address:
  • Phone: 609-905-5340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. MARK SOBIECH
Title or Position: PRESIDENT
Credential:
Phone: 609-905-5340