Provider Demographics
NPI:1790112134
Name:DPSP HEALTHCARE LLC
Entity Type:Organization
Organization Name:DPSP HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:OGREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-308-2163
Mailing Address - Street 1:102 HEARTHSTONE DR
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08009-9550
Mailing Address - Country:US
Mailing Address - Phone:856-308-2163
Mailing Address - Fax:856-481-4068
Practice Address - Street 1:401 S EVERGREEN AVE
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-2740
Practice Address - Country:US
Practice Address - Phone:856-308-2163
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ04A015311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home