Provider Demographics
NPI:1437461159
Name:TOTALIFECARE
Entity Type:Organization
Organization Name:TOTALIFECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:YESID
Authorized Official - Middle Name:
Authorized Official - Last Name:ARCHILA
Authorized Official - Suffix:
Authorized Official - Credentials:MB
Authorized Official - Phone:908-220-6342
Mailing Address - Street 1:82 CEDAR LN # 176
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07203-3059
Mailing Address - Country:US
Mailing Address - Phone:908-259-5865
Mailing Address - Fax:
Practice Address - Street 1:82 CEDAR LN 176
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:NJ
Practice Address - Zip Code:07203
Practice Address - Country:US
Practice Address - Phone:908-259-5865
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-10
Last Update Date:2010-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP0141600251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherEIN