MEDICARE: ARK HOMECARE INC

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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1790459261
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARK HOMECARE INC

Provider Business Mailing Address
First Line	:	1 ETHEL RD STE 102B
Second Line	:
City	:	EDISON
State	:	NJ
Zip	:	08817-2838
Country	:	US
Telephone Number	:	908-293-2852
Fax Number	:	908-293-2853

Provider Business Practice Location Address
First Line	:	44 APPLE ST STE 3
Second Line	:
City	:	TINTON FALLS
State	:	NJ
Zip	:	07724-2672
Country	:	US
Telephone Number	:	908-293-2852
Fax Number	:	908-293-2853

Authorized Official
Title or Position	:	CEO
Name	:	MRS. GRACE ENABOSI
Credential	:
Telephone Number	:	908-293-2852

Provider Enumeration Date	:	08/06/2021
Last Update Date	:	05/31/2024

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