MEDICARE: PROMISE HEALTH CARE NURSING SERVICE NJ 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1184222713
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROMISE HEALTH CARE NURSING SERVICE NJ INC

Provider Business Mailing Address
First Line	:	12 NORTHFIELD CT
Second Line	:
City	:	HAZLET
State	:	NJ
Zip	:	07730-1259
Country	:	US
Telephone Number	:	732-888-1012
Fax Number	:	732-553-3000

Provider Business Practice Location Address
First Line	:	12 NORTHFIELD CT
Second Line	:
City	:	HAZLET
State	:	NJ
Zip	:	07730-1259
Country	:	US
Telephone Number	:	732-888-1012
Fax Number	:	732-553-3000

Authorized Official
Title or Position	:	OWNER
Name	:	KEHINDE BRENDA OLATUBOSUN
Credential	:	RN, BSN
Telephone Number	:	732-888-1012

Provider Enumeration Date	:	10/15/2020
Last Update Date	:	08/20/2021

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