1396744074 NPI number — CHS HOME SUPPORT SERVICES

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 1396744074 NPI number — CHS HOME SUPPORT SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHS HOME SUPPORT SERVICES
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:
Provider Other Organization Name Type Code:
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:
1396744074
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 POWER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAUPPAUGE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11788-4229
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-940-3350
Provider Business Mailing Address Fax Number:
631-940-3405

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 POWER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAUPPAUGE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11788-4229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-940-3350
Provider Business Practice Location Address Fax Number:
631-940-3405
Provider Enumeration Date:
07/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HUGHES
Authorized Official First Name:
GARNET
Authorized Official Middle Name:
GAY
Authorized Official Title or Position:
DIR OF SECURITY, PRIVACY, COMPLIANC
Authorized Official Telephone Number:
631-940-3350

Provider Taxonomy Codes

  • Taxonomy code: 251F00000X , with the licence number:  025107 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , 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)

  • Identifier: 02205392 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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