Healthcare Provider Details

I. General information

NPI: 1376679365
Provider Name (Legal Business Name): VINELAND CUIDADO CASERO HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 02/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 W LANDIS AVE
VINELAND NJ
08360-8122
US

IV. Provider business mailing address

1110 N CARROLL AVE
SOUTHLAKE TX
76092-5306
US

V. Phone/Fax

Practice location:
  • Phone: 856-696-9991
  • Fax: 856-696-9982
Mailing address:
  • Phone: 817-310-1100
  • Fax: 817-310-1197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHPO223201
License Number StateNJ

VIII. Authorized Official

Name: DR. CARMEN SANTIAGO
Title or Position: CEO
Credential: BSN
Phone: 817-310-1100