Healthcare Provider Details

I. General information

NPI: 1699553628
Provider Name (Legal Business Name): ROLANDA S BREWER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2023
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 ARK RD STE 208N
MOUNT LAUREL NJ
08054-3190
US

IV. Provider business mailing address

14 WAGON WHEEL DR
SICKLERVILLE NJ
08081-4802
US

V. Phone/Fax

Practice location:
  • Phone: 856-729-6813
  • Fax: 888-919-2610
Mailing address:
  • Phone: 856-729-6813
  • Fax: 888-919-2610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHP0329200
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: