1902946304 NPI number — IDAM HOME CARE SERVICES

Table of content: (NPI 1902946304)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902946304 NPI number — IDAM HOME CARE SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IDAM HOME CARE SERVICES
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:
1902946304
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2572 S BROAD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMILTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08610-4018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-888-4844
Provider Business Mailing Address Fax Number:
609-888-3443

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2572 S BROAD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMILTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08610-4018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-888-4844
Provider Business Practice Location Address Fax Number:
609-888-3443
Provider Enumeration Date:
02/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GRIFFITHS
Authorized Official First Name:
IAN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
609-888-4844

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HP0022100 , 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: 0048747 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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