MEDICARE: LTC HEALTH SERVICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	26NJ00055300	NJ

General Provider Information

NPI Number	:	1053565614
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LTC HEALTH SERVICES INC

Provider Business Mailing Address
First Line	:	1358 HOOPER AVE # 289
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08753-2882
Country	:	US
Telephone Number	:	732-281-0934
Fax Number	:	732-281-5565

Provider Business Practice Location Address
First Line	:	1358 HOOPER AVE # 289
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08753-2882
Country	:	US
Telephone Number	:	732-281-0934
Fax Number	:	732-281-5565

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. DENISE SCHAFF
Credential	:	APN-C
Telephone Number	:	732-281-0934

Provider Enumeration Date	:	11/10/2008
Last Update Date	:	11/10/2008

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Directions to “LTC HEALTH SERVICES INC ” Practice Location

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