=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306604061
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAVENDER HOME CARE AGENCY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2024
-----------------------------------------------------
Last Update Date | 03/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 160 LITTLETON RD
-----------------------------------------------------
City | PARSIPPANY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07054-1871
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-304-5313
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 434 RIDGEDALE AVE STE 11
-----------------------------------------------------
City | EAST HANOVER
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07936-1450
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-304-5313
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | KATE A OKUSANYA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 908-304-5313
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------