Healthcare Provider Details

I. General information

NPI: 1164280350
Provider Name (Legal Business Name): SSP HOME HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2024
Last Update Date: 03/12/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

197 HILLSIDE AVE
LIVINGSTON NJ
07039-3648
US

IV. Provider business mailing address

197 HILLSIDE AVE
LIVINGSTON NJ
07039-3648
US

V. Phone/Fax

Practice location:
  • Phone: 646-633-1525
  • Fax:
Mailing address:
  • Phone: 646-633-1525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: DR. IYEN STACEY IGHODARO
Title or Position: OWNER
Credential: DNP, APRN, FNP-C
Phone: 646-633-1525