Provider Demographics
NPI:1578774287
Name:BOARDWALK HOMECARE
Entity Type:Organization
Organization Name:BOARDWALK HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRENDAN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-361-7901
Mailing Address - Street 1:1706 STATE ROUTE 33
Mailing Address - Street 2:SUITE 3
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-4908
Mailing Address - Country:US
Mailing Address - Phone:732-361-7901
Mailing Address - Fax:732-807-3104
Practice Address - Street 1:1706 STATE ROUTE 33
Practice Address - Street 2:SUITE 3
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4908
Practice Address - Country:US
Practice Address - Phone:732-361-7901
Practice Address - Fax:732-807-3104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP0089600251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health