Provider Demographics
NPI:1255621629
Name:TRI-STATE HEALTH & HOMECARE AGENCY,INC.
Entity type:Organization
Organization Name:TRI-STATE HEALTH & HOMECARE AGENCY,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MR
Authorized Official - First Name:OLUBUNMI
Authorized Official - Middle Name:
Authorized Official - Last Name:ADETULE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-517-7915
Mailing Address - Street 1:3 MARSHALL ST APT 7R
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-8715
Mailing Address - Country:US
Mailing Address - Phone:973-517-7915
Mailing Address - Fax:
Practice Address - Street 1:3 MARSHALL STREET APT 7R
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111
Practice Address - Country:US
Practice Address - Phone:973-517-7915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR15005500251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health