1750673679 NPI number — COMPLETE HOME CARE SERVICES, 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 1750673679 NPI number — COMPLETE HOME CARE SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPLETE HOME CARE SERVICES, 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:
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:
1750673679
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10820 62ND DR APT 2B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOREST HILLS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11375-1213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-528-5493
Provider Business Mailing Address Fax Number:
718-525-4305

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20514 LINDEN BLVD STE 204
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT ALBANS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11412-2934
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-528-5493
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/11/2011

Additional Information

Authorized Official

Authorized Official Last Name:
IBRAGIMOV
Authorized Official First Name:
DAVRON
Authorized Official Middle Name:
Authorized Official Title or Position:
RN
Authorized Official Telephone Number:
513-544-8163

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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