Healthcare Provider Details

I. General information

NPI: 1932546785
Provider Name (Legal Business Name): CUSTODIAL CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2013
Last Update Date: 06/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 US HIGHWAY 9 SUITE C, 2ND FLOOR
SOUTH AMBOY NJ
08879-3320
US

IV. Provider business mailing address

980 US HIGHWAY 9 SUITE C, 2ND FLOOR
SOUTH AMBOY NJ
08879-3320
US

V. Phone/Fax

Practice location:
  • Phone: 732-753-9888
  • Fax: 732-753-9889
Mailing address:
  • Phone: 732-753-9888
  • Fax: 732-753-9889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHP0156600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberHP0156600
License Number StateNJ

VIII. Authorized Official

Name: DENNIS PE
Title or Position: MANAGING OWNER
Credential:
Phone: 732-753-9888