=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295064277
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VITACARE SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/21/2009
-----------------------------------------------------
Last Update Date | 12/21/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5 STONEHURST DR
-----------------------------------------------------
City | VOORHEES
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08043-2808
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-626-0461
-----------------------------------------------------
Fax | 856-626-3340
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5 STONEHURST DR
-----------------------------------------------------
City | VOORHEES
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08043-2808
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-626-0461
-----------------------------------------------------
Fax | 856-626-3340
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | MR. ATIF AHMAD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 856-626-0461
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number | HP0135600
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------