Provider Demographics
NPI:1790214708
Name:2ND HOME TOTOWA LLC
Entity Type:Organization
Organization Name:2ND HOME TOTOWA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:OLLECH
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:973-355-0555
Mailing Address - Street 1:494 BROAD ST RM 302
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-3217
Mailing Address - Country:US
Mailing Address - Phone:973-355-0555
Mailing Address - Fax:973-268-2644
Practice Address - Street 1:120 COMMERCE WAY
Practice Address - Street 2:
Practice Address - City:TOTOWA
Practice Address - State:NJ
Practice Address - Zip Code:07512-1158
Practice Address - Country:US
Practice Address - Phone:347-406-2621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-05
Last Update Date:2017-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care