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General NPI Number Information
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NPI Number | 1629478201
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Entity Type | Organization
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Legal Business Name | 360 DEGREE CARE
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Dates
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Enumeration Date | 09/02/2014
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Last Update Date | 09/02/2014
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Provider Practice Location Address
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Address Line | 45 N BROAD ST
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-3856
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Country | US
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Telephone | 201-299-4243
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Fax |
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Provider Business Mailing Address
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Address Line | 45 N BROAD ST
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-3856
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Country | US
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Telephone | 201-299-4243
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Fax |
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Authorized Official
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Title or Position | CHAIRMAN
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Name | JEFF DEJOSEPH
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Credential |
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Telephone | 201-299-4243
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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 |
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License Number State |
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