1679514509 NPI number — BASIC HOME INFUSION, LLC

Table of content: (NPI 1679514509)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679514509 NPI number — BASIC HOME INFUSION, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BASIC HOME INFUSION, 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:
BASIC HOME INFUSION
Provider Other Organization Name Type Code:
3
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:
1679514509
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1401 VALLEY RD
Provider Second Line Business Mailing Address:
4TH FLOOR
Provider Business Mailing Address City Name:
WAYNE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07470-2073
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-475-0500
Provider Business Mailing Address Fax Number:
973-706-8009

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1401 VALLEY RD
Provider Second Line Business Practice Location Address:
4TH FLOOR
Provider Business Practice Location Address City Name:
WAYNE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07470-2073
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-475-0500
Provider Business Practice Location Address Fax Number:
973-706-8009
Provider Enumeration Date:
06/10/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RECINE
Authorized Official First Name:
MARILYNN
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING DIRECTOR
Authorized Official Telephone Number:
888-822-7428

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336H0001X , with the licence number: 28RS00513100 , 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: 7219709 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2053773 . This is a "PK" identifier . This identifiers is of the category "OTHER".