Provider Demographics
NPI:1114236890
Name:GRACE REILLY GERIATRIC HOUSE CALLS LLC
Entity Type:Organization
Organization Name:GRACE REILLY GERIATRIC HOUSE CALLS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:REILLY
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN, APN
Authorized Official - Phone:732-239-3113
Mailing Address - Street 1:618 YELLOWBRICK RD
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-3334
Mailing Address - Country:US
Mailing Address - Phone:732-239-3113
Mailing Address - Fax:
Practice Address - Street 1:618 YELLOWBRICK RD
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-3334
Practice Address - Country:US
Practice Address - Phone:732-239-3113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-29
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty