Provider Demographics
NPI:1639329527
Name:AWCA HOME CARE AGENCY, INC.
Entity Type:Organization
Organization Name:AWCA HOME CARE AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:MYUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-862-9111
Mailing Address - Street 1:9 GENESEE AVE.
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666
Mailing Address - Country:US
Mailing Address - Phone:201-862-9111
Mailing Address - Fax:201-862-0005
Practice Address - Street 1:9 GENESEE AVE
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-5923
Practice Address - Country:US
Practice Address - Phone:201-862-9111
Practice Address - Fax:201-862-1662
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASIAN WOMEN'S CHRISTIAN ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-26
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP0038100251E00000X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty