Provider Demographics
NPI:1356474407
Name:VISITING HOMEMAKER SERVICE OF WARREN COUNTY, INC.
Entity Type:Organization
Organization Name:VISITING HOMEMAKER SERVICE OF WARREN COUNTY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SUYDAM
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BA
Authorized Official - Phone:908-689-4140
Mailing Address - Street 1:PO BOX 306
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07882-0306
Mailing Address - Country:US
Mailing Address - Phone:908-689-4140
Mailing Address - Fax:908-689-8909
Practice Address - Street 1:18 BROAD ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07882-1909
Practice Address - Country:US
Practice Address - Phone:908-689-4140
Practice Address - Fax:908-689-8909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP0204000251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0060101Medicaid