Provider Demographics
NPI:1326373523
Name:NEW PROVIDENCE HOME HEALTH CARE SERVICES
Entity Type:Organization
Organization Name:NEW PROVIDENCE HOME HEALTH CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BONIFACE EGUZOUWA
Authorized Official - Middle Name:ONYEBUCHI
Authorized Official - Last Name:EGUZOUWA
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:717-599-1855
Mailing Address - Street 1:56 SCHELLER RD
Mailing Address - Street 2:
Mailing Address - City:NEW PROVIDENCE
Mailing Address - State:PA
Mailing Address - Zip Code:17560-9713
Mailing Address - Country:US
Mailing Address - Phone:717-786-9254
Mailing Address - Fax:717-786-9135
Practice Address - Street 1:56 SCHELLER RD
Practice Address - Street 2:
Practice Address - City:NEW PROVIDENCE
Practice Address - State:PA
Practice Address - Zip Code:17560-9713
Practice Address - Country:US
Practice Address - Phone:717-786-9254
Practice Address - Fax:717-786-9135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-06
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA03780501251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA398125Medicare Oscar/Certification