Provider Demographics
NPI:1376902197
Name:PRIDECARE, INC.
Entity Type:Organization
Organization Name:PRIDECARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:A
Authorized Official - Last Name:MIRRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-494-3121
Mailing Address - Street 1:1341 HAMBURG TPKE
Mailing Address - Street 2:SUITE 2-2
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-4060
Mailing Address - Country:US
Mailing Address - Phone:973-832-4301
Mailing Address - Fax:973-832-4303
Practice Address - Street 1:1341 HAMBURG TPKE
Practice Address - Street 2:SUITE 2-2
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-4060
Practice Address - Country:US
Practice Address - Phone:973-832-4301
Practice Address - Fax:973-832-4303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-22
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP0174000251F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion