MEDICARE: SECURA HOME HEALTH 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

General Provider Information

NPI Number	:	1518357011
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SECURA HOME HEALTH LLC

Provider Business Mailing Address
First Line	:	611 ROUTE 46 WEST
Second Line	:	SUITE 200
City	:	HASBROUCK HEIGHTS
State	:	NJ
Zip	:	07604
Country	:	US
Telephone Number	:	201-403-9300
Fax Number	:

Provider Business Practice Location Address
First Line	:	6406 BERGENLINE AVE
Second Line	:
City	:	WEST NEW YORK
State	:	NJ
Zip	:	07093-1634
Country	:	US
Telephone Number	:	201-854-5508
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DONNA LODATO
Credential	:
Telephone Number	:	201-403-9300

Provider Enumeration Date	:	02/04/2015
Last Update Date	:	02/04/2015

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