Provider Demographics
NPI:1083149975
Name:MOM AND PAP'S HOME CARE AGENCY, LLC
Entity Type:Organization
Organization Name:MOM AND PAP'S HOME CARE AGENCY, LLC
Other - Org Name:MOM AND PAP'S HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ENA
Authorized Official - Middle Name:E
Authorized Official - Last Name:FORBES
Authorized Official - Suffix:
Authorized Official - Credentials:PRESIDENT
Authorized Official - Phone:201-567-3181
Mailing Address - Street 1:50 E PALISADE AVE
Mailing Address - Street 2:2ND FLOOR SUITE 206
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2933
Mailing Address - Country:US
Mailing Address - Phone:201-567-3181
Mailing Address - Fax:201-567-1122
Practice Address - Street 1:50 E PALISADE AVE
Practice Address - Street 2:2ND FLOOR SUITE 206
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2933
Practice Address - Country:US
Practice Address - Phone:201-567-3181
Practice Address - Fax:201-567-1122
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOM AND PAP'S HOME CARE AGENCY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-04-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP0256500251E00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care