Provider Demographics
NPI:1205310018
Name:CITADEL AT HOME LLC
Entity type:Organization
Organization Name:CITADEL AT HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-965-0366
Mailing Address - Street 1:1000 GATES AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-6296
Mailing Address - Country:US
Mailing Address - Phone:917-805-0702
Mailing Address - Fax:718-280-1050
Practice Address - Street 1:7 GLENWOOD AVE STE 412
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07017-1041
Practice Address - Country:US
Practice Address - Phone:973-965-0366
Practice Address - Fax:973-965-0367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-18
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJHP0282000OtherNJ OFFICE OF THE ATTORNEY GENERAL - DIVISION OF CONSUMER AFFAIRS