Provider Demographics
NPI:1518670785
Name:LONGLIVE HOME CARE NJ
Entity Type:Organization
Organization Name:LONGLIVE HOME CARE NJ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-623-0255
Mailing Address - Street 1:10304 EATON PL STE 100
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2221
Mailing Address - Country:US
Mailing Address - Phone:703-942-9400
Mailing Address - Fax:
Practice Address - Street 1:1 BRIDGE PLAZA NORTH CENTRAL ROAD
Practice Address - Street 2:SUITE 675
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024
Practice Address - Country:US
Practice Address - Phone:703-742-7400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health