Provider Demographics
NPI:1164280350
Name:SSP HOME HEALTHCARE LLC
Entity Type:Organization
Organization Name:SSP HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IYEN
Authorized Official - Middle Name:STACEY
Authorized Official - Last Name:IGHODARO
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN, FNP-C
Authorized Official - Phone:646-633-1525
Mailing Address - Street 1:197 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-3648
Mailing Address - Country:US
Mailing Address - Phone:646-633-1525
Mailing Address - Fax:
Practice Address - Street 1:197 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-3648
Practice Address - Country:US
Practice Address - Phone:646-633-1525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child