Provider Demographics
NPI:1184379281
Name:OCEANWIDE SERVICES CORP
Entity type:Organization
Organization Name:OCEANWIDE SERVICES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:YUNGLIM
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-277-4360
Mailing Address - Street 1:21 GRAND AVE STE 124
Mailing Address - Street 2:
Mailing Address - City:PALISADES PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07650-1077
Mailing Address - Country:US
Mailing Address - Phone:201-613-2113
Mailing Address - Fax:
Practice Address - Street 1:400 38TH ST STE 222
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-4848
Practice Address - Country:US
Practice Address - Phone:201-277-4360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health