Provider Demographics
NPI:1275394942
Name:SUNDANCE HOME CARE, INC DBA GRISWOLD HOME CARE MERCER/MIDDLESEX COUNTI
Entity Type:Organization
Organization Name:SUNDANCE HOME CARE, INC DBA GRISWOLD HOME CARE MERCER/MIDDLESEX COUNTI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:MANDALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-236-5968
Mailing Address - Street 1:780 LIVINGSTON AVE.
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902
Mailing Address - Country:US
Mailing Address - Phone:732-745-7788
Mailing Address - Fax:732-377-7230
Practice Address - Street 1:780 LIVINGSTON AVE.
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902
Practice Address - Country:US
Practice Address - Phone:732-745-7788
Practice Address - Fax:732-377-7230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-19
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health