Healthcare Provider Details

I. General information

NPI: 1174063200
Provider Name (Legal Business Name): VHSNJ AT HOME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2017
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 GARRET MOUNTAIN PLZ STE 4
WOODLAND PARK NJ
07424-3352
US

IV. Provider business mailing address

783 RIVERVIEW DR STE1A
TOTOWA NJ
07511-1007
US

V. Phone/Fax

Practice location:
  • Phone: 973-256-4636
  • Fax: 973-256-6778
Mailing address:
  • Phone: 973-256-4636
  • Fax: 973-256-6778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number22608
License Number StateNJ

VIII. Authorized Official

Name: MS. MICHELLE M MENDELSON
Title or Position: VICE PRESIDENT HOME CARE
Credential: RN, MSN
Phone: 732-751-3713