Provider Demographics
NPI:1912362815
Name:EXECUTIVE HOME HEALTHCARE
Entity Type:Organization
Organization Name:EXECUTIVE HOME HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:NIRVELYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:JEAN-SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-534-7871
Mailing Address - Street 1:17 N HOPE CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527
Mailing Address - Country:US
Mailing Address - Phone:732-534-7871
Mailing Address - Fax:
Practice Address - Street 1:17 N HOPE CHAPEL RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527
Practice Address - Country:US
Practice Address - Phone:732-534-7871
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-18
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0450022464251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health