1700533049 NPI number — JEFFHOME PA, LLC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700533049 NPI number — JEFFHOME PA, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEFFHOME PA, 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:
1700533049
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4300 HADDONFIELD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PENNSAUKEN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08109-3376
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-909-5159
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2275 BRIDGE ST UNIT 208D
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19137-1306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-413-0600
Provider Business Practice Location Address Fax Number:
215-413-0722
Provider Enumeration Date:
03/07/2022

Additional Information

Authorized Official

Authorized Official Last Name:
BAIADA
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
856-662-4300

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)





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