Provider Demographics
NPI:1114195815
Name:TOTAL CARE LLC
Entity Type:Organization
Organization Name:TOTAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILFREDO TOMAS
Authorized Official - Middle Name:CORREA
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-632-4579
Mailing Address - Street 1:328 RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-1311
Mailing Address - Country:US
Mailing Address - Phone:973-632-4579
Mailing Address - Fax:201-653-7960
Practice Address - Street 1:201 SAINT PAULS AVE
Practice Address - Street 2:SUITE 1D
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-3724
Practice Address - Country:US
Practice Address - Phone:201-656-7400
Practice Address - Fax:201-653-7960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07690500261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care