Provider Demographics
NPI:1386279180
Name:PETEMOMMY'S PLACE LLC
Entity type:Organization
Organization Name:PETEMOMMY'S PLACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JURDIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:GARRETT-HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-341-3624
Mailing Address - Street 1:PO BOX 2234
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07019-2234
Mailing Address - Country:US
Mailing Address - Phone:973-640-3827
Mailing Address - Fax:
Practice Address - Street 1:70 BEDFORD ST
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-1830
Practice Address - Country:US
Practice Address - Phone:917-341-3624
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-12
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care