Basic Information
| Provider Information | |||||||||
| NPI: | 1003942004 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LOVING CARE AGENCY, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 611 ROUTE 46 WEST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | HASBROUCK HEIGHTS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076043118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2014039300 | ||||||||
| FaxNumber: | 2014039262 | ||||||||
| Practice Location | |||||||||
| Address1: | 2600 MOUNT EPHRAIM AVE | ||||||||
| Address2: | SUITE 415 | ||||||||
| City: | CAMDEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 081043236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8566351000 | ||||||||
| FaxNumber: | 8566351200 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2007 | ||||||||
| LastUpdateDate: | 04/21/2011 | ||||||||
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| AuthorizedOfficialLastName: | CREAMER | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | F. | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 2014039310 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | HP0076205 | NJ | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 9028901 | 05 | NJ | MEDICAID |