Provider Demographics
NPI:1477985075
Name:ST.BERNADINE HOME CARE SERVICES, LLC
Entity Type:Organization
Organization Name:ST.BERNADINE HOME CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BERNARDINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-360-3640
Mailing Address - Street 1:591 SUMMIT AVE
Mailing Address - Street 2:SUITE 411
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-2714
Mailing Address - Country:US
Mailing Address - Phone:201-360-3640
Mailing Address - Fax:201-918-2207
Practice Address - Street 1:591 SUMMIT AVE
Practice Address - Street 2:SUITE 411
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-2714
Practice Address - Country:US
Practice Address - Phone:201-360-3640
Practice Address - Fax:201-918-2207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0400556742251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health