Provider Demographics
NPI:1285643130
Name:PEAK HOME BASED REHABILITATION LLC
Entity Type:Organization
Organization Name:PEAK HOME BASED REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KERI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-746-9001
Mailing Address - Street 1:297 KINDERKAMACK RD STE 101
Mailing Address - Street 2:SUITE 278
Mailing Address - City:ORADELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07649-1535
Mailing Address - Country:US
Mailing Address - Phone:201-264-2322
Mailing Address - Fax:
Practice Address - Street 1:297 KINDERKAMACK RD STE 101
Practice Address - Street 2:SUITE 278
Practice Address - City:ORADELL
Practice Address - State:NJ
Practice Address - Zip Code:07649-1535
Practice Address - Country:US
Practice Address - Phone:201-264-2322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2014-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00832000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty