Provider Demographics
NPI:1942542147
Name:EXECUTIVE HOME CARE, LLC
Entity Type:Organization
Organization Name:EXECUTIVE HOME CARE, LLC
Other - Org Name:EXCUTIVE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:VERKHOGLAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-489-4899
Mailing Address - Street 1:270 STATE ST
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-5501
Mailing Address - Country:US
Mailing Address - Phone:201-489-4899
Mailing Address - Fax:201-489-5899
Practice Address - Street 1:270 STATE ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-5501
Practice Address - Country:US
Practice Address - Phone:201-489-4899
Practice Address - Fax:201-489-5899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP0164600251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health