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General NPI Number Information
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NPI Number | 1053565614
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Entity Type | Organization
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Legal Business Name | LTC HEALTH SERVICES INC
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Dates
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Enumeration Date | 11/10/2008
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Last Update Date | 11/10/2008
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Provider Practice Location Address
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Address Line | 1358 HOOPER AVE # 289
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City | TOMS RIVER
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State | NJ
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Zip | 08753-2882
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Country | US
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Telephone | 732-281-0934
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Fax | 732-281-5565
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Provider Business Mailing Address
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Address Line | 1358 HOOPER AVE # 289
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City | TOMS RIVER
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State | NJ
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Zip | 08753-2882
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Country | US
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Telephone | 732-281-0934
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Fax | 732-281-5565
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. DENISE SCHAFF
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Credential | APN-C
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Telephone | 732-281-0934
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 26NJ00055300
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License Number State | NJ
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