Provider Demographics
NPI:1538461892
Name:JFK/MERIDIAN HOME CARE SERVICES LLC
Entity Type:Organization
Organization Name:JFK/MERIDIAN HOME CARE SERVICES LLC
Other - Org Name:HACKENSACK MERIDIAN HEALTH JFK AT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDELSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN
Authorized Official - Phone:732-751-3713
Mailing Address - Street 1:485B US HIGHWAY 1 STE 400
Mailing Address - Street 2:
Mailing Address - City:ISELIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08830-3013
Mailing Address - Country:US
Mailing Address - Phone:732-317-5777
Mailing Address - Fax:732-317-5740
Practice Address - Street 1:485B US HIGHWAY 1 STE 400
Practice Address - Street 2:
Practice Address - City:ISELIN
Practice Address - State:NJ
Practice Address - Zip Code:08830-3013
Practice Address - Country:US
Practice Address - Phone:732-317-5777
Practice Address - Fax:732-517-5740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-18
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ72001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ317059Medicare Oscar/Certification