Provider Demographics
NPI:1720255193
Name:STACY TRISTER LLC
Entity Type:Organization
Organization Name:STACY TRISTER LLC
Other - Org Name:VISITING ANGELS OF FORT LEE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:TRISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-242-0305
Mailing Address - Street 1:2125 CENTER AVENUE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024
Mailing Address - Country:US
Mailing Address - Phone:201-242-0305
Mailing Address - Fax:201-242-0345
Practice Address - Street 1:2125 CENTER AVE STE 111
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-5820
Practice Address - Country:US
Practice Address - Phone:201-242-0305
Practice Address - Fax:201-242-0345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP0078900251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health