MEDICARE: ALT BEST PRACTICES BHOM2, 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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1669008405
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALT BEST PRACTICES BHOM2, LLC

Provider Business Mailing Address
First Line	:	81 CROOKED STICK RD
Second Line	:
City	:	JACKSON
State	:	NJ
Zip	:	08527-4032
Country	:	US
Telephone Number	:	848-218-0790
Fax Number	:	732-358-0829

Provider Business Practice Location Address
First Line	:	81 CROOKED STICK RD
Second Line	:
City	:	JACKSON
State	:	NJ
Zip	:	08527-4032
Country	:	US
Telephone Number	:	848-218-0790
Fax Number	:	732-358-0829

Authorized Official
Title or Position	:	AUTHORIZED REPRESENTATIVE
Name	:	DAVID GOLD
Credential	:
Telephone Number	:	848-218-0790

Provider Enumeration Date	:	03/12/2020
Last Update Date	:	03/12/2020

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