Provider Demographics
NPI:1477028926
Name:HENLUCY HEALTH SYSTEM LLC
Entity Type:Organization
Organization Name:HENLUCY HEALTH SYSTEM LLC
Other - Org Name:HENLUCY HEALTH HOME CARE LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OLAPEMI
Authorized Official - Middle Name:O
Authorized Official - Last Name:OBOLANLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:862-930-6688
Mailing Address - Street 1:68 GARSIDE ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-1006
Mailing Address - Country:US
Mailing Address - Phone:862-930-6688
Mailing Address - Fax:862-930-6689
Practice Address - Street 1:68 GARSIDE ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-1006
Practice Address - Country:US
Practice Address - Phone:862-930-6688
Practice Address - Fax:862-930-6689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-11
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========Medicaid