Provider Demographics
NPI:1952035545
Name:HOME BASE THERAPY LLC
Entity Type:Organization
Organization Name:HOME BASE THERAPY LLC
Other - Org Name:HOME BASE REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:NAVA
Authorized Official - Middle Name:
Authorized Official - Last Name:POLATSEK
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:845-517-7802
Mailing Address - Street 1:194 WILDER ST
Mailing Address - Street 2:
Mailing Address - City:HILLSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07205-3128
Mailing Address - Country:US
Mailing Address - Phone:845-517-7802
Mailing Address - Fax:
Practice Address - Street 1:194 WILDER ST
Practice Address - Street 2:
Practice Address - City:HILLSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07205-3128
Practice Address - Country:US
Practice Address - Phone:845-517-7802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-11
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty