=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154350908
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BAYADA NURSES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 S NEW YORK AVE SUITE 401
-----------------------------------------------------
City | ATLANTIC CITY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08401-8012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-441-9100
-----------------------------------------------------
Fax | 609-441-0777
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 EXECUTIVE DR SUITE 4
-----------------------------------------------------
City | MOORESTOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08057-4236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-793-1703
-----------------------------------------------------
Fax | 856-439-0412
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF REIMBURSEMENT
-----------------------------------------------------
Name | STEPHEN P FLANNERY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 856-793-1703
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HP0015324
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------