Healthcare Provider Details

I. General information

NPI: 1568154268
Provider Name (Legal Business Name): KHIDMA KHADIM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 05/23/2023
Certification Date: 05/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 COLBY AVE STE 92
STRATFORD NJ
08084-1000
US

IV. Provider business mailing address

7595 BOULEVARD AVE STE 92
PENNSAUKEN NJ
08110-2576
US

V. Phone/Fax

Practice location:
  • Phone: 185-660-2260
  • Fax:
Mailing address:
  • Phone: 856-602-2607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: SADE BETHEA EL
Title or Position: CEO
Credential:
Phone: 856-602-2607