Provider Demographics
NPI:1184222713
Name:PROMISE HEALTH CARE NURSING SERVICE NJ INC
Entity Type:Organization
Organization Name:PROMISE HEALTH CARE NURSING SERVICE NJ INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEHINDE
Authorized Official - Middle Name:BRENDA
Authorized Official - Last Name:OLATUBOSUN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:732-888-1012
Mailing Address - Street 1:12 NORTHFIELD CT
Mailing Address - Street 2:
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730-1259
Mailing Address - Country:US
Mailing Address - Phone:732-888-1012
Mailing Address - Fax:732-553-3000
Practice Address - Street 1:12 NORTHFIELD CT
Practice Address - Street 2:
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1259
Practice Address - Country:US
Practice Address - Phone:732-888-1012
Practice Address - Fax:732-553-3000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-15
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health