Healthcare Provider Details

I. General information

NPI: 1164118717
Provider Name (Legal Business Name): HEPHZIBAH HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 04/17/2023
Certification Date: 04/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 W PASSAIC ST STE 1
ROCHELLE PARK NJ
07662-3019
US

IV. Provider business mailing address

340 W PASSAIC ST STE 1
ROCHELLE PARK NJ
07662-3019
US

V. Phone/Fax

Practice location:
  • Phone: 201-546-8969
  • Fax:
Mailing address:
  • Phone: 201-546-8969
  • 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: DINAH BOAMAH-NYARKO
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 929-497-4240