Basic Information
| Provider Information | |||||||||
| NPI: | 1881162352 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HMH RESIDENTIAL CARE, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1340 PARK AVE | ||||||||
| Address2: | |||||||||
| City: | PLAINFIELD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070603227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9087543100 | ||||||||
| FaxNumber: | 7326321644 | ||||||||
| Practice Location | |||||||||
| Address1: | 1340 PARK AVE | ||||||||
| Address2: | |||||||||
| City: | PLAINFIELD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070603227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9087543100 | ||||||||
| FaxNumber: | 7326321644 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2018 | ||||||||
| LastUpdateDate: | 11/02/2018 | ||||||||
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| AuthorizedOfficialLastName: | LEMAIRE | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT DIVERSIFIED VENTURES | ||||||||
| AuthorizedOfficialTelephone: | 7327517520 | ||||||||
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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 | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 4504305 | 05 | NJ | MEDICAID |