=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558085928
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAFEWAY TRANSITIONAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2022
-----------------------------------------------------
Last Update Date | 09/29/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18 DINA LN
-----------------------------------------------------
City | SOMERSET
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08873-7611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-507-7832
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18 DINA LN
-----------------------------------------------------
City | SOMERSET
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08873-7611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-507-7832
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. CHARLES EJIKE ONYEJIAKA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 908-507-7832
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------