Provider Demographics
NPI:1912461641
Name:WHITE DOVE HEALTH AGENCY
Entity Type:Organization
Organization Name:WHITE DOVE HEALTH AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WATSO N
Authorized Official - Middle Name:
Authorized Official - Last Name:PESSU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-704-5644
Mailing Address - Street 1:82 NORTHRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MAYS LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:08330-4920
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:82 NORTHRIDGE DR
Practice Address - Street 2:
Practice Address - City:MAYS LANDING
Practice Address - State:NJ
Practice Address - Zip Code:08330-4920
Practice Address - Country:US
Practice Address - Phone:973-704-5644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-28
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health