Provider Demographics
NPI:1619211851
Name:HOME ADVANTAGE REHAB LLC
Entity Type:Organization
Organization Name:HOME ADVANTAGE REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WINOGRAD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:201-704-4411
Mailing Address - Street 1:1 HARPER ST
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-3635
Mailing Address - Country:US
Mailing Address - Phone:201-704-4411
Mailing Address - Fax:862-520-5206
Practice Address - Street 1:1 HARPER ST
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-3635
Practice Address - Country:US
Practice Address - Phone:201-704-4411
Practice Address - Fax:862-520-5206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-10
Last Update Date:2012-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00789300251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health