MEDICARE: VHSNJ AT HOME, 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	71603	NJ

General Provider Information

NPI Number	:	1518407642
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VHSNJ AT HOME, LLC

Provider Business Mailing Address
First Line	:	3 GARRET MOUNTAIN PLZ STE 4
Second Line	:
City	:	WOODLAND PARK
State	:	NJ
Zip	:	07424-3352
Country	:	US
Telephone Number	:	973-256-4636
Fax Number	:	973-256-6778

Provider Business Practice Location Address
First Line	:	3 GARRET MOUNTAIN PLZ STE 4
Second Line	:
City	:	WOODLAND PARK
State	:	NJ
Zip	:	07424-3352
Country	:	US
Telephone Number	:	973-256-4636
Fax Number	:	973-256-6778

Authorized Official
Title or Position	:	VICE PRESIDENT HOME CARE
Name	:	MS. MICHELLE M MENDELSON
Credential	:	RN, MSN
Telephone Number	:	732-751-3713

Provider Enumeration Date	:	03/08/2017
Last Update Date	:	03/25/2021

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