Provider Demographics
NPI:1477040897
Name:LIVING DEMENTIA WELL AT HOME COMPANY
Entity type:Organization
Organization Name:LIVING DEMENTIA WELL AT HOME COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRANQUILLI
Authorized Official - Suffix:
Authorized Official - Credentials:CDP, CDCM, CADDCT
Authorized Official - Phone:908-651-5625
Mailing Address - Street 1:308 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-2055
Mailing Address - Country:US
Mailing Address - Phone:908-651-5625
Mailing Address - Fax:908-651-5631
Practice Address - Street 1:302 MAIN ST
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-2004
Practice Address - Country:US
Practice Address - Phone:908-651-5625
Practice Address - Fax:908-651-5631
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIVING DEMENTIA EDUCATION & TRAINING INSTITUTE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-20
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP0276000251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJHP0276000OtherHOME HEALTH AGENCY