MEDICARE: OCEANWIDE SERVICES CORP

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	:	1184379281
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCEANWIDE SERVICES CORP

Provider Business Mailing Address
First Line	:	21 GRAND AVE STE 124
Second Line	:
City	:	PALISADES PARK
State	:	NJ
Zip	:	07650-1077
Country	:	US
Telephone Number	:	201-613-2113
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 38TH ST STE 222
Second Line	:
City	:	UNION CITY
State	:	NJ
Zip	:	07087-4848
Country	:	US
Telephone Number	:	201-277-4360
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	YUNGLIM KIM
Credential	:
Telephone Number	:	201-277-4360

Provider Enumeration Date	:	02/16/2022
Last Update Date	:	02/16/2022

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Directions to “OCEANWIDE SERVICES CORP ” Practice Location

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