Healthcare Provider Details

I. General information

NPI: 1528679602
Provider Name (Legal Business Name): SUPPORTIVE HOUSING OPTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2020
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 MARTINE AVE
PLAINFIELD NJ
07060-3127
US

IV. Provider business mailing address

150 MAPLE AVE STE 141
SOUTH PLAINFIELD NJ
07080-3407
US

V. Phone/Fax

Practice location:
  • Phone: 908-209-1193
  • Fax:
Mailing address:
  • Phone: 908-209-1193
  • Fax: 908-753-4327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MS. TRACEY C GRAY-WALKER
Title or Position: CEO
Credential:
Phone: 908-209-1193