Healthcare Provider Details

I. General information

NPI: 1124694781
Provider Name (Legal Business Name): LUCHIEE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 06/02/2021
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

454 MORRIS AVE
SPRINGFIELD NJ
07081-1158
US

IV. Provider business mailing address

5 HEMLOCK TER
SPRINGFIELD NJ
07081-2405
US

V. Phone/Fax

Practice location:
  • Phone: 908-922-1727
  • Fax:
Mailing address:
  • Phone: 908-922-1727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. OLUCHI CHILAKA
Title or Position: NP
Credential: DNP, APN
Phone: 908-922-1727