Provider Demographics
NPI:1023358561
Name:HOSPITAL TO HOME TRANSITIONAL DIABETES CARE LIMITED LIABILITY COMPANY
Entity type:Organization
Organization Name:HOSPITAL TO HOME TRANSITIONAL DIABETES CARE LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DONNELL-JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:APN-C
Authorized Official - Phone:856-889-9577
Mailing Address - Street 1:67 STRATTON LN
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-2253
Mailing Address - Country:US
Mailing Address - Phone:856-889-9577
Mailing Address - Fax:
Practice Address - Street 1:67 STRATTON LN
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2253
Practice Address - Country:US
Practice Address - Phone:856-889-9577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-20
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty