Provider Demographics
NPI:1891186979
Name:SUPPORTIVE CARE OF NEW JERSEY, LLC
Entity type:Organization
Organization Name:SUPPORTIVE CARE OF NEW JERSEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:KARTISEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-482-6630
Mailing Address - Street 1:383 KINGS HWY N
Mailing Address - Street 2:SUITE 213
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-1014
Mailing Address - Country:US
Mailing Address - Phone:856-482-6630
Mailing Address - Fax:
Practice Address - Street 1:383 KINGS HWY N
Practice Address - Street 2:SUITE 213
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-1014
Practice Address - Country:US
Practice Address - Phone:856-482-6630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-11
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health