1427563741 NPI number — OSPREY HOME HEALTH LLC

Table of content: (NPI 1427563741)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427563741 NPI number — OSPREY HOME HEALTH LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OSPREY HOME HEALTH 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:
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:
1427563741
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/29/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
646 ROUTE 18 NORTH
Provider Second Line Business Mailing Address:
BLDG. A, SUITE 205
Provider Business Mailing Address City Name:
EAST BRUNSWICK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08816-3722
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-210-4240
Provider Business Mailing Address Fax Number:
732-210-4251

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
646 ROUTE 18 NORTH
Provider Second Line Business Practice Location Address:
BLDG. A, SUITE 205
Provider Business Practice Location Address City Name:
EAST BRUNSWICK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08816-3722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-210-4240
Provider Business Practice Location Address Fax Number:
732-210-4251
Provider Enumeration Date:
12/08/2017

Additional Information

Authorized Official

Authorized Official Last Name:
BEGUN
Authorized Official First Name:
GALINA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
732-210-4240

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0670430 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0450222203 . This is a "CERTIFICATE OF FORMATION" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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