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General NPI Number Information
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NPI Number | 1114266269
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Entity Type | Organization
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Legal Business Name | ULTRACARE FAMILY WELLNESS, INC.
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Dates
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Enumeration Date | 02/10/2013
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Last Update Date | 02/10/2013
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Provider Practice Location Address
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Address Line | 404 WHITEWOOD RD
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City | UNION
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State | NJ
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Zip | 07083-8217
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Country | US
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Telephone | 646-894-4166
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Fax |
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Provider Business Mailing Address
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Address Line | 404 WHITEWOOD RD
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City | UNION
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State | NJ
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Zip | 07083-8217
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Country | US
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Telephone | 646-894-4166
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/FOUNDER
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Name | MR. DESMOND JOHNSON
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Credential | MBA
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Telephone | 646-894-4166
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 0400317931
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License Number State | NJ
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