Provider Demographics
NPI:1154108272
Name:CARING HANDS GROUP HOME LLC
Entity type:Organization
Organization Name:CARING HANDS GROUP HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MICKUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:862-282-2404
Mailing Address - Street 1:6 MCKINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07506-2508
Mailing Address - Country:US
Mailing Address - Phone:862-282-2404
Mailing Address - Fax:
Practice Address - Street 1:6 MCKINLEY AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NJ
Practice Address - Zip Code:07506-2508
Practice Address - Country:US
Practice Address - Phone:862-282-2404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities