Healthcare Provider Details

I. General information

NPI: 1003729302
Provider Name (Legal Business Name): ETHANO CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2026
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 TILLINGHAST ST APT 1
NEWARK NJ
07108-1422
US

IV. Provider business mailing address

70 TILLINGHAST ST APT 1
NEWARK NJ
07108-1422
US

V. Phone/Fax

Practice location:
  • Phone: 929-351-4172
  • Fax:
Mailing address:
  • Phone: 929-351-4172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JOY MITCHELL-THOMAS
Title or Position: MD
Credential:
Phone: 551-276-8420