Provider Demographics
NPI:1700383676
Name:MEDVALE HOME CARE LLC
Entity Type:Organization
Organization Name:MEDVALE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAJUSTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-688-1025
Mailing Address - Street 1:574 PURCE ST
Mailing Address - Street 2:
Mailing Address - City:HILLSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07205-1743
Mailing Address - Country:US
Mailing Address - Phone:908-688-1025
Mailing Address - Fax:908-688-0706
Practice Address - Street 1:574 PURCE ST
Practice Address - Street 2:
Practice Address - City:HILLSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07205-1743
Practice Address - Country:US
Practice Address - Phone:908-688-1025
Practice Address - Fax:908-688-0706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health