1720201767 NPI number — HOME HEALTH CARE STAFFING ACQUISITION LLC

Table of content: (NPI 1720201767)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720201767 NPI number — HOME HEALTH CARE STAFFING ACQUISITION LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOME HEALTH CARE STAFFING ACQUISITION LLC
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:
SUPPORTIVE 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:
1720201767
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 EAST 89TH ST.
Provider Second Line Business Mailing Address:
19B
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10128-4300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-672-9433
Provider Business Mailing Address Fax Number:
646-607-9595

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
383 KINGS HWY N
Provider Second Line Business Practice Location Address:
SUITE 213
Provider Business Practice Location Address City Name:
CHERRY HILL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08034-1014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-482-6630
Provider Business Practice Location Address Fax Number:
856-482-6632
Provider Enumeration Date:
04/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PERKAL
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
MARC
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
646-672-9433

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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