Provider Demographics
NPI:1528592078
Name:NJ GOLDEN HOME CARE
Entity Type:Organization
Organization Name:NJ GOLDEN HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HATEM
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDELAZIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-390-8768
Mailing Address - Street 1:46 MAIN ST STE 108
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-1910
Mailing Address - Country:US
Mailing Address - Phone:908-469-5720
Mailing Address - Fax:
Practice Address - Street 1:46 MAIN ST STE 108
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-1910
Practice Address - Country:US
Practice Address - Phone:908-469-5720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0547166Medicaid