=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639355720
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BERGEN CARE HOME HEALTH, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/18/2008
-----------------------------------------------------
Last Update Date | 05/10/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 365 W. PASSAIC STREET SUITE 115
-----------------------------------------------------
City | ROCHELLE PARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07662
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-358-2666
-----------------------------------------------------
Fax | 201-358-0836
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 365 W. PASSAIC STREET SUITE 115
-----------------------------------------------------
City | ROCHELLE PARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07662
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-358-2666
-----------------------------------------------------
Fax | 201-358-0836
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | SERENA NIEHAUS
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 201-358-2666
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------