Healthcare Provider Details

I. General information

NPI: 1477028926
Provider Name (Legal Business Name): HENLUCY HEALTH SYSTEM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2018
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 GARSIDE ST
NEWARK NJ
07104-1006
US

IV. Provider business mailing address

68 GARSIDE ST
NEWARK NJ
07104-1006
US

V. Phone/Fax

Practice location:
  • Phone: 862-930-6688
  • Fax: 862-930-6689
Mailing address:
  • Phone: 862-930-6688
  • Fax: 862-930-6689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
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 Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: OLAPEMI O OBOLANLE
Title or Position: PRESIDENT
Credential:
Phone: 862-930-6688