Provider Demographics
NPI:1922302207
Name:BUTTONWOOD RESIDENT SERVICES LLC
Entity Type:Organization
Organization Name:BUTTONWOOD RESIDENT SERVICES LLC
Other - Org Name:VISITING ANGELSOC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR LLC MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOMBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-240-1050
Mailing Address - Street 1:1826A HOOPER AVE
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-8163
Mailing Address - Country:US
Mailing Address - Phone:732-240-1050
Mailing Address - Fax:
Practice Address - Street 1:1826A HOOPER AVE
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-8163
Practice Address - Country:US
Practice Address - Phone:732-240-1050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-31
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP0149000251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health