Provider Demographics
NPI:1033383377
Name:KNM HOME HEALTH CARE AGENCY, LLC
Entity Type:Organization
Organization Name:KNM HOME HEALTH CARE AGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALISA
Authorized Official - Middle Name:L
Authorized Official - Last Name:OGLESBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-265-1000
Mailing Address - Street 1:PO BOX 484
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08048-0484
Mailing Address - Country:US
Mailing Address - Phone:609-265-1000
Mailing Address - Fax:609-265-9976
Practice Address - Street 1:14 COTTONWOOD DR
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NJ
Practice Address - Zip Code:08048-5240
Practice Address - Country:US
Practice Address - Phone:609-265-1000
Practice Address - Fax:609-265-9976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP0068700251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0685100OtherJACC/CAP/GO
NJ=========OtherREAL LIFE CHOICES