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General NPI Number Information
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NPI Number | 1275045155
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Entity Type | Organization
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Legal Business Name | ELDIVINE CARE LLC
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Dates
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Enumeration Date | 10/31/2017
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Last Update Date | 10/31/2017
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Provider Practice Location Address
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Address Line | 142 MIDLAND PL
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City | NEWARK
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State | NJ
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Zip | 07106-3311
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Country | US
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Telephone | 973-207-9886
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Fax | 973-416-2825
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Provider Business Mailing Address
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Address Line | 142 MIDLAND PL
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City | NEWARK
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State | NJ
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Zip | 07106-3311
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Country | US
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Telephone | 973-207-9886
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Fax | 973-416-2825
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. EVANGELINE N. EZIKE
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Credential | RN
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Telephone | 973-207-9886
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 282E00000X
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Taxonomy Name | Long Term Care Hospital
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3140N1450X
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Taxonomy Name | Pediatric Skilled Nursing Facility
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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