Provider Demographics
NPI:1720227879
Name:2ND HOME PASSAIC OPERATIONS, LLC
Entity Type:Organization
Organization Name:2ND HOME PASSAIC OPERATIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-395-0555
Mailing Address - Street 1:37 N DAY ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07050-3608
Mailing Address - Country:US
Mailing Address - Phone:973-395-0555
Mailing Address - Fax:973-395-0560
Practice Address - Street 1:63 GROVE ST
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-5001
Practice Address - Country:US
Practice Address - Phone:973-395-0555
Practice Address - Fax:973-395-0560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care