1104055888 NPI number — HOME SWEET HOMECARE OF LI INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104055888 NPI number — HOME SWEET HOMECARE OF LI INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOME SWEET HOMECARE OF LI INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CATHIE'S CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104055888
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4747 NESCONSET HWY
Provider Second Line Business Mailing Address:
UNIT 28
Provider Business Mailing Address City Name:
PORT JEFFERSON ST
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11776
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-828-8874
Provider Business Mailing Address Fax Number:
631-473-0870

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4747 NESCONSET HWY
Provider Second Line Business Practice Location Address:
UNIT 28
Provider Business Practice Location Address City Name:
PORT JEFFERSON STA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11776
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-828-8874
Provider Business Practice Location Address Fax Number:
631-473-0870
Provider Enumeration Date:
07/02/2009

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
CATHERINE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
631-828-8874

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  1551L-001 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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