Provider Demographics
NPI:1083297162
Name:EXPERIENCE CARE NJ INC
Entity Type:Organization
Organization Name:EXPERIENCE CARE NJ INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LIZATTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:667-500-4579
Mailing Address - Street 1:1260 OLD COUNTRYSIDE CIR
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-5828
Mailing Address - Country:US
Mailing Address - Phone:667-500-4579
Mailing Address - Fax:
Practice Address - Street 1:1260 OLD COUNTRYSIDE CIR
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-5828
Practice Address - Country:US
Practice Address - Phone:667-500-4579
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care