=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912412495
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTH AMERICAN LIFE SCIENCES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2017
-----------------------------------------------------
Last Update Date | 12/06/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 CONANT ST
-----------------------------------------------------
City | HILLSIDE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07205-2706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-220-0395
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2076 WESTFIELD ROAD CIR
-----------------------------------------------------
City | SCOTCH PLAINS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07076-1818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MATTHEW HAMILTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 973-220-0395
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------