Healthcare Provider Details

I. General information

NPI: 1346890084
Provider Name (Legal Business Name): IDEAL HEALTHCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2019
Last Update Date: 10/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 OVERLOOK CTR
PRINCETON NJ
08540-7814
US

IV. Provider business mailing address

100 OVERLOOK CTR STE 2018
PRINCETON NJ
08540-7814
US

V. Phone/Fax

Practice location:
  • Phone: 412-482-0594
  • Fax:
Mailing address:
  • Phone: 412-482-0594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: IDA MICHEL
Title or Position: OWNER
Credential:
Phone: 412-482-0594