=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366076507
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VALKCREST STAFFING HOME HEALTHCARE CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2020
-----------------------------------------------------
Last Update Date | 02/28/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 119 ROSEWOOD DR
-----------------------------------------------------
City | BORDENTOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08505-4816
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-372-3814
-----------------------------------------------------
Fax | 609-447-0610
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 119 ROSEWOOD DR
-----------------------------------------------------
City | BORDENTOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08505-4816
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-372-3814
-----------------------------------------------------
Fax | 609-447-0610
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | IKE O ALLISON
-----------------------------------------------------
Credential | MR
-----------------------------------------------------
Telephone | 609-372-3814
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------