Provider Demographics
NPI:1114655339
Name:EXPO SIGNATURE HOME CARE
Entity Type:Organization
Organization Name:EXPO SIGNATURE HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATE
Authorized Official - Middle Name:ANNEHCHILE
Authorized Official - Last Name:OKUSANYA
Authorized Official - Suffix:
Authorized Official - Credentials:DNP,ANC-BC, RN
Authorized Official - Phone:908-304-5313
Mailing Address - Street 1:1727 US HIGHWAY 130 STE 6
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-3084
Mailing Address - Country:US
Mailing Address - Phone:732-955-9575
Mailing Address - Fax:732-955-9577
Practice Address - Street 1:1727 US HIGHWAY 130 STE 6
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-3084
Practice Address - Country:US
Practice Address - Phone:732-955-9575
Practice Address - Fax:732-955-9577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJNAMedicaid