MEDICARE: SKJ HEALTH ENTERPRISES 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	253Z00000X	In Home Supportive Care Agency	HP0193100	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	HP0193100	OTHER	NJ	NJ OFFICE OF THE ATTORNEY GENERAL - DIVISION OF CONSUMER AFFAIRS

General Provider Information

NPI Number	:	1952708828
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SKJ HEALTH ENTERPRISES INC.

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	:	732-587-6606

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	:	732-587-6606

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. SCOTT A. STICKLER
Credential	:
Telephone Number	:	732-272-0222

Provider Enumeration Date	:	11/20/2014
Last Update Date	:	11/20/2014

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