1922688829 NPI number — BELOVED CARE HOME AGENCY SERVICES LLC

Table of content: (NPI 1922688829)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922688829 NPI number — BELOVED CARE HOME AGENCY SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BELOVED CARE HOME AGENCY SERVICES 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:
1922688829
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
61 VALLEY WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST ORANGE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07052-5829
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
175 N PARK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST ORANGE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07017-1893
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-381-8590
Provider Business Practice Location Address Fax Number:
973-928-8502
Provider Enumeration Date:
04/13/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GEORGES
Authorized Official First Name:
MARIE KETTY
Authorized Official Middle Name:
VICTOR
Authorized Official Title or Position:
CERTIFIED SENIOR CARE MANAGER
Authorized Official Telephone Number:
862-224-4957

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: HP0312500 . This is a "NJ STATE LICENSE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".