Provider Demographics
NPI:1144420670
Name:BROADWAY RESPITE AND HOME CARE, LLC
Entity Type:Organization
Organization Name:BROADWAY RESPITE AND HOME CARE, LLC
Other - Org Name:BRC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ERROL
Authorized Official - Middle Name:
Authorized Official - Last Name:SELTZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-797-1177
Mailing Address - Street 1:2420 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-3057
Mailing Address - Country:US
Mailing Address - Phone:201-797-1177
Mailing Address - Fax:201-796-3344
Practice Address - Street 1:2420 BROADWAY
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-3057
Practice Address - Country:US
Practice Address - Phone:201-797-1177
Practice Address - Fax:201-796-3344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP0100300251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health