Provider Demographics
NPI:1093306201
Name:CARABALLO CARES ADVANCED PRACTICE SERVICES LLC
Entity Type:Organization
Organization Name:CARABALLO CARES ADVANCED PRACTICE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARABALLO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:215-432-4218
Mailing Address - Street 1:2720 ROUTE 42 STE 215
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-4001
Mailing Address - Country:US
Mailing Address - Phone:856-535-2040
Mailing Address - Fax:
Practice Address - Street 1:2720 ROUTE 42 STE 215
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-4001
Practice Address - Country:US
Practice Address - Phone:856-535-2040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-30
Last Update Date:2021-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty