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General NPI Number Information
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NPI Number | 1942824040
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Entity Type | Organization
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Legal Business Name | SPARKLING CLEAN HOME CARE LLC
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Dates
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Enumeration Date | 06/04/2020
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Last Update Date | 06/04/2020
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Provider Practice Location Address
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Address Line | 28 VALLEY RD
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City | MONTCLAIR
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State | NJ
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Zip | 07042-2709
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Country | US
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Telephone | 973-980-2624
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Fax | 973-744-6283
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Provider Business Mailing Address
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Address Line | 45 HIGH ST
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City | MONTCLAIR
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State | NJ
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Zip | 07042-2401
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Country | US
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Telephone | 973-980-2624
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Fax | 973-980-2624
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Authorized Official
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Title or Position | OWNER
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Name | JO-ANN JEFFERSON
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Credential | CNA
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Telephone | 973-980-2624
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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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