Healthcare Provider Details

I. General information

NPI: 1285643130
Provider Name (Legal Business Name): PEAK HOME BASED REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 03/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

297 KINDERKAMACK RD STE 101 SUITE 278
ORADELL NJ
07649-1535
US

IV. Provider business mailing address

297 KINDERKAMACK RD STE 101 SUITE 278
ORADELL NJ
07649-1535
US

V. Phone/Fax

Practice location:
  • Phone: 201-264-2322
  • Fax:
Mailing address:
  • Phone: 201-264-2322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number40QA00832000
License Number StateNJ

VIII. Authorized Official

Name: MRS. KERI LYNN MORAN
Title or Position: OWNER PHYSICAL THERAPIST
Credential:
Phone: 201-746-9001