MEDICARE: PRAD HEALTH ENTERPRISES 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	HP0237900	NJ

General Provider Information

NPI Number	:	1841740479
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRAD HEALTH ENTERPRISES LLC

Provider Business Mailing Address
First Line	:	106 APPLE ST
Second Line	:	SUITE 113
City	:	TINTON FALLS
State	:	NJ
Zip	:	07724-2669
Country	:	US
Telephone Number	:	732-272-0222
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 APPLE ST
Second Line	:	SUITE 113
City	:	TINTON FALLS
State	:	NJ
Zip	:	07724-2669
Country	:	US
Telephone Number	:	732-272-0222
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	TRACIE E AHERN
Credential	:
Telephone Number	:	732-272-0222

Provider Enumeration Date	:	10/06/2016
Last Update Date	:	10/06/2016

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