Healthcare Provider Details

I. General information

NPI: 1245911536
Provider Name (Legal Business Name): HEALTH SERVE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2023
Last Update Date: 07/28/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 N MAIN ST STE C4
WILLIAMSTOWN NJ
08094-1476
US

IV. Provider business mailing address

375 N MAIN ST STE C4
WILLIAMSTOWN NJ
08094-1476
US

V. Phone/Fax

Practice location:
  • Phone: 856-288-2878
  • Fax:
Mailing address:
  • Phone: 856-288-2878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. MOHAMED MUCTARR BAH
Title or Position: CEO
Credential:
Phone: 732-309-7098