MEDICARE: 2ND HOME UNION CITY OPERATIONS, 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	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1588803357
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	2ND HOME UNION CITY OPERATIONS, LLC

Provider Business Mailing Address
First Line	:	3610 PALISADE AVE
Second Line	:
City	:	UNION CITY
State	:	NJ
Zip	:	07087-4718
Country	:	US
Telephone Number	:	201-864-0400
Fax Number	:	201-864-6834

Provider Business Practice Location Address
First Line	:	3610 PALISADE AVE
Second Line	:
City	:	UNION CITY
State	:	NJ
Zip	:	07087-4718
Country	:	US
Telephone Number	:	201-864-0400
Fax Number	:	201-864-6834

Authorized Official
Title or Position	:	COO
Name	:	MR. SAM OLLECH
Credential	:
Telephone Number	:	973-395-0555

Provider Enumeration Date	:	02/18/2009
Last Update Date	:	05/14/2026

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