=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043178353
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PROFESSIONAL SVC OF SOUTH JERSEY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/14/2026
-----------------------------------------------------
Last Update Date | 01/14/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 GREENTREE RD STE B
-----------------------------------------------------
City | BLACKWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08012-1572
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-593-4247
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 GREENTREE RD STE B
-----------------------------------------------------
City | BLACKWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08012-1572
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-593-4247
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | ROBERT ARMSTRONG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 856-515-4160
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------