=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063910396
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NASUS SENIORS VETERANS AND MORE INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/01/2018
-----------------------------------------------------
Last Update Date | 12/14/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19-03 MAPLE AVE STE 7
-----------------------------------------------------
City | FAIR LAWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07410-1553
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-282-2444
-----------------------------------------------------
Fax | 888-608-6794
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6421 CALEDON CT
-----------------------------------------------------
City | LOCUST GROVE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30248-7402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | SUSAN MARTINEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 727-267-6977
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------