Healthcare Provider Details

I. General information

NPI: 1609206671
Provider Name (Legal Business Name): PRIMARY CARE FOR THE HOMEBOUND PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2013
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

271 GROVE AVE STE A
VERONA NJ
07044-1731
US

IV. Provider business mailing address

290 W MOUNT PLEASANT AVE STE 2400
LIVINGSTON NJ
07039-2761
US

V. Phone/Fax

Practice location:
  • Phone: 973-239-2600
  • Fax: 833-484-1686
Mailing address:
  • Phone: 973-559-3700
  • Fax: 833-484-1686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA04268300
License Number StateNJ

VIII. Authorized Official

Name: RONISHA KATRINA SCALES
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 973-559-3700