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General NPI Number Information
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NPI Number | 1285151670
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Entity Type | Organization
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Legal Business Name | BROADWAY RESPITE AND HOME CARE, LLC
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Dates
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Enumeration Date | 08/25/2017
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Last Update Date | 08/25/2017
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Provider Practice Location Address
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Address Line | 17-17 BROADWAY
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City | FAIR LAWN
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State | NJ
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Zip | 07410
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Country | US
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Telephone | 201-703-3980
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Fax | 201-703-3984
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Provider Business Mailing Address
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Address Line | 17-17 BROADWAY
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City | FAIR LAWN
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State | NJ
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Zip | 07410
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Country | US
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Telephone | 201-703-3980
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Fax | 201-703-3984
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | ANASTASIA VAYNBERG
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Credential |
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Telephone | 201-703-3980
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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 | 1266913
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License Number State | NJ
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