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NPI Code Detail

MEDICARE: ADVANCE SUPPORT SERVICES AND HOMECARE LLC

MEDICARE: ADVANCE SUPPORT SERVICES AND HOMECARE 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
1251E00000XHome Health Agency

General Provider Information

NPI Number : 1902670110
Entity Type Code : Organization
Provider Name (Legal Business Name) : ADVANCE SUPPORT SERVICES AND HOMECARE LLC
Provider Business Mailing Address
First Line : 14 WARREN CT
Second Line :
City : OLD BRIDGE
State : NJ
Zip : 08857-1824
Country : US
Telephone Number : 917-497-6791
Fax Number :
Provider Business Practice Location Address
First Line : 14 WARREN CT
Second Line :
City : OLD BRIDGE
State : NJ
Zip : 08857-1824
Country : US
Telephone Number : 917-497-6791
Fax Number :
Authorized Official
Title or Position : OWNER
Name : FUNKE AJIBOYE
Credential :
Telephone Number : 917-497-6791
Provider Enumeration Date : 11/08/2023
Last Update Date : 11/08/2023

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Directions to “ADVANCE SUPPORT SERVICES AND HOMECARE LLC ” Practice Location

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