Provider Demographics
NPI:1558040360
Name:NJ LIFECARE INNOVATION HOME CARE LLC
Entity Type:Organization
Organization Name:NJ LIFECARE INNOVATION HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBR
Authorized Official - Prefix:
Authorized Official - First Name:ASMITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-790-8245
Mailing Address - Street 1:154 MAIN ST UNIT 8
Mailing Address - Street 2:
Mailing Address - City:EAST RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07073-1842
Mailing Address - Country:US
Mailing Address - Phone:201-790-8245
Mailing Address - Fax:
Practice Address - Street 1:154 MAIN ST UNIT 8
Practice Address - Street 2:
Practice Address - City:EAST RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07073-1842
Practice Address - Country:US
Practice Address - Phone:201-790-8245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health