Provider Demographics
NPI:1811192230
Name:JC HOME HEALTHCARE, INC
Entity type:Organization
Organization Name:JC HOME HEALTHCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILSON
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-486-2662
Mailing Address - Street 1:18 LOCKWOOD DR
Mailing Address - Street 2:# 47
Mailing Address - City:ROSELLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07203-3065
Mailing Address - Country:US
Mailing Address - Phone:908-486-2662
Mailing Address - Fax:
Practice Address - Street 1:18 LOCKWOOD DR
Practice Address - Street 2:# 47
Practice Address - City:ROSELLE
Practice Address - State:NJ
Practice Address - Zip Code:07203-3065
Practice Address - Country:US
Practice Address - Phone:908-486-2662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-16
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP0050400251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health