Healthcare Provider Details

I. General information

NPI: 1669036687
Provider Name (Legal Business Name): AYDAN HIGH QUALITY HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2019
Last Update Date: 06/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 E WOOD ST STE 305
VINELAND NJ
08360
US

IV. Provider business mailing address

629 E WOOD ST STE 305
VINELAND NJ
08360-3731
US

V. Phone/Fax

Practice location:
  • Phone: 856-449-4664
  • Fax:
Mailing address:
  • Phone: 856-449-4664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MR. DARYL STAFFORD JR.
Title or Position: OWNER
Credential: LPN
Phone: 856-449-4664