Provider Demographics
NPI:1518320886
Name:HEALING AT HOME, LLC
Entity type:Organization
Organization Name:HEALING AT HOME, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FNP-BC
Authorized Official - Prefix:
Authorized Official - First Name:JENEE
Authorized Official - Middle Name:P
Authorized Official - Last Name:SKINNER-HAMLER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:609-241-9232
Mailing Address - Street 1:200 WALT WHITMAN AVE UNIT 1022
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-8050
Mailing Address - Country:US
Mailing Address - Phone:609-241-9232
Mailing Address - Fax:609-216-7447
Practice Address - Street 1:517 MAIN ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NJ
Practice Address - Zip Code:08048-1125
Practice Address - Country:US
Practice Address - Phone:609-241-9232
Practice Address - Fax:609-216-7447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-03
Last Update Date:2024-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00582400302R00000X
207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No302R00000XManaged Care OrganizationsHealth Maintenance OrganizationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ440787ZV6JOtherMEDICARE
NJ440787ZV6JOtherFAMILY MEDICINE