Provider Demographics
NPI:1316943533
Name:EMBRACING HOSPICECARE OF NEW JERSEY,LLC
Entity type:Organization
Organization Name:EMBRACING HOSPICECARE OF NEW JERSEY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:TANGOLICS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-974-2545
Mailing Address - Street 1:3349 ROUTE 138
Mailing Address - Street 2:BUILDING D, SUITE F
Mailing Address - City:WALL
Mailing Address - State:NJ
Mailing Address - Zip Code:07719
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3349 ROUTE 138
Practice Address - Street 2:BUILDING D, SUITE F
Practice Address - City:WALL
Practice Address - State:NJ
Practice Address - Zip Code:07719
Practice Address - Country:US
Practice Address - Phone:732-974-2545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ23087251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0011517Medicaid
NJ0011517Medicaid