MEDICARE: JERSEY STAKE LLC

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	251E00000X	Home Health Agency
2	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1093444721
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JERSEY STAKE LLC

Provider Business Mailing Address
First Line	:	19 ORCHARD PL
Second Line	:
City	:	HAWTHORNE
State	:	NJ
Zip	:	07506-3123
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2125 CENTER AVE STE 110
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-5821
Country	:	US
Telephone Number	:	201-242-0305
Fax Number	:	201-242-0345

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MICHAEL TUCCI
Credential	:
Telephone Number	:	201-242-0305

Provider Enumeration Date	:	06/08/2022
Last Update Date	:	01/12/2023

Similar Medicare Providers

1437423498 — TAKA HEALTH LLC
Practice Location Address:

1084 LEE RD STE 4
ORLANDO, FL
32810-5821

Practice Phone: 407-730-2770
Practice Fax: 407-730-2764

1588074058 — MARCIA NATHAN
Practice Location Address:

1084 LEE RD , SUITE 7
ORLANDO, FL
32810-5821

Practice Phone: 407-953-8714
Practice Fax: 407-293-8891

1952412850 — DR. GARY ALLEN HAWTHORNE D.M.D.
Practice Location Address:

1803 S GREENWOOD AVE
FORT SMITH, AR
72901-5821

Practice Phone: 479-782-2487
Practice Fax: 479-782-8838

1841399664 — GARY A. HAWTHORNE, D.M.D., P.A.
Practice Location Address:

1803 S GREENWOOD AVE
FORT SMITH, AR
72901-5821

Practice Phone: 479-782-2487
Practice Fax: 479-782-8838

1972824415 — MS. CHERYL ANDREA SCOTT LPC
Practice Location Address:

4421 PADRE COURT
FORT WORTH, TX
76244-5821

Practice Phone: 682-459-3094
Practice Fax: 817-423-7384

1013430180 — LEAGUE FOR THE BLIND AND DISABLED, INC
Practice Location Address:

5821 S ANTHONY BLVD
FORT WAYNE, IN
46816-3701

Practice Phone: 260-441-0551
Practice Fax: 260-441-7760

Directions to “JERSEY STAKE LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.