1417497785 NPI number — PEREGRINE HOMECARE

Table of content: (NPI 1417497785)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417497785 NPI number — PEREGRINE HOMECARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEREGRINE HOMECARE
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:
1417497785
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1551 EAST GENESEE STREET
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
SKANEATELES
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13152
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-685-5170
Provider Business Mailing Address Fax Number:
315-685-5186

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1551 EAST GENESEE STREET
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SKANEATELES
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13152-8879
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-685-5170
Provider Business Practice Location Address Fax Number:
315-685-5186
Provider Enumeration Date:
03/06/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KALET-CLARE
Authorized Official First Name:
CASSANDRA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
315-685-5170

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  1509L001 , 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)