Provider Demographics
NPI:1871971259
Name:LOVING HOME CARE PROFESSIONALS LLC
Entity type:Organization
Organization Name:LOVING HOME CARE PROFESSIONALS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VERLENE
Authorized Official - Middle Name:LORRAINE
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:862-930-3819
Mailing Address - Street 1:137 EVERGREEN PL
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-2005
Mailing Address - Country:US
Mailing Address - Phone:862-930-3819
Mailing Address - Fax:
Practice Address - Street 1:137 EVERGREEN PL
Practice Address - Street 2:SUITE 2C
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-2005
Practice Address - Country:US
Practice Address - Phone:862-930-3819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-18
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP0202500251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0473880Medicaid