Healthcare Provider Details

I. General information

NPI: 1235066671
Provider Name (Legal Business Name): GROUPHOME.CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 PENNSYLVANIA AVE
UNION NJ
07083-6943
US

IV. Provider business mailing address

927 PENNSYLVANIA AVE
UNION NJ
07083-6943
US

V. Phone/Fax

Practice location:
  • Phone: 862-576-3404
  • Fax:
Mailing address:
  • Phone: 862-576-3404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KETSIA CETOUTE
Title or Position: MANAGING MEMBER
Credential: BSN, RN
Phone: 862-576-3404