Provider Demographics
NPI:1750005633
Name:TESSANEKA HILL LLC
Entity type:Organization
Organization Name:TESSANEKA HILL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:DWANE
Authorized Official - Middle Name:
Authorized Official - Last Name:EVERETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-977-7093
Mailing Address - Street 1:1676 N OLDEN AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08638-3210
Mailing Address - Country:US
Mailing Address - Phone:609-250-2920
Mailing Address - Fax:609-250-2919
Practice Address - Street 1:1676 N OLDEN AVE STE 3
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08638-3210
Practice Address - Country:US
Practice Address - Phone:609-250-2920
Practice Address - Fax:609-250-2919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health