Basic Information
| Provider Information | |||||||||
| NPI: | 1659773075 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VENUS MEDICAL STAFFING, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 610 HOMESTEAD RD | ||||||||
| Address2: | |||||||||
| City: | BRIELLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087302020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7323007637 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1579 OLD FREEHOLD ROAD | ||||||||
| Address2: | |||||||||
| City: | TOMS RIVER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08755 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7325054477 | ||||||||
| FaxNumber: | 7323492949 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2014 | ||||||||
| LastUpdateDate: | 09/17/2014 | ||||||||
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| AuthorizedOfficialLastName: | UPMANIS | ||||||||
| AuthorizedOfficialFirstName: | TERESA | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7325054477 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | HP0166300 | 01 | NJ | NJ CONSUMER AFFAIRS | OTHER |