Provider Demographics
NPI:1598278004
Name:MOMCARES GROUP HOME LLC.
Entity Type:Organization
Organization Name:MOMCARES GROUP HOME LLC.
Other - Org Name:MOMCARES GROUP HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOI
Authorized Official - Suffix:
Authorized Official - Credentials:RN/BSN
Authorized Official - Phone:603-233-6924
Mailing Address - Street 1:21 HIGH ACRE DR
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-4717
Mailing Address - Country:US
Mailing Address - Phone:603-233-6924
Mailing Address - Fax:
Practice Address - Street 1:260 WILDFLOWER LN
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-4872
Practice Address - Country:US
Practice Address - Phone:603-233-6924
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-07
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services