=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750046405
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | S&K PASSION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2021
-----------------------------------------------------
Last Update Date | 11/07/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1461 CRANLEIGH LN
-----------------------------------------------------
City | WILLIAMSTOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08094-3636
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-889-8538
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1461 CRANLEIGH LN
-----------------------------------------------------
City | WILLIAMSTOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08094-3636
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | SCHOLASTICA A MULUH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 443-889-8535
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------