Provider Demographics
NPI:1336890508
Name:STATEWIDE FAMILY CARE
Entity type:Organization
Organization Name:STATEWIDE FAMILY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:GHISLAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:EUSTACHE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:973-609-3294
Mailing Address - Street 1:44 GLENWOOD AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07017-1557
Mailing Address - Country:US
Mailing Address - Phone:973-609-3294
Mailing Address - Fax:973-324-1260
Practice Address - Street 1:44 GLENWOOD AVE STE 204
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07017-1557
Practice Address - Country:US
Practice Address - Phone:973-609-3294
Practice Address - Fax:973-324-1260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health