Provider Demographics
NPI:1235785122
Name:SPECIAL PRIVATE HOME CARE
Entity Type:Organization
Organization Name:SPECIAL PRIVATE HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT
Authorized Official - Prefix:
Authorized Official - First Name:BIHOSA
Authorized Official - Middle Name:N
Authorized Official - Last Name:TYSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-245-9430
Mailing Address - Street 1:100 RYDERS LN STE 5-255
Mailing Address - Street 2:
Mailing Address - City:MILLTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08850-1263
Mailing Address - Country:US
Mailing Address - Phone:732-245-9430
Mailing Address - Fax:732-360-8624
Practice Address - Street 1:1808 CYPRESS LN
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5269
Practice Address - Country:US
Practice Address - Phone:732-245-9430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Single Specialty