1417128364 NPI number — ADD-HOME, LLC

Table of content: MRS. PATRICIA ANN PAYNE (NPI 1881967990)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417128364 NPI number — ADD-HOME, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADD-HOME, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417128364
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1220 ROUTE 46 WEST
Provider Second Line Business Mailing Address:
SUITE 209
Provider Business Mailing Address City Name:
PARSIPPANY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07054
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-588-7170
Provider Business Mailing Address Fax Number:
973-402-0877

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1220 ROUTE 46 WEST
Provider Second Line Business Practice Location Address:
SUITE 209
Provider Business Practice Location Address City Name:
PARSIPPANY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-588-7170
Provider Business Practice Location Address Fax Number:
973-402-0877
Provider Enumeration Date:
03/19/2008

Additional Information

Authorized Official

Authorized Official Last Name:
DUARTE
Authorized Official First Name:
ADARIA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
OWNER/CEO
Authorized Official Telephone Number:
973-588-7170

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HP0108400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: HP0108400 . This is a "HEALTH CARE SERVICE FIRM" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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