1356679252 NPI number — IDEAL HOME CARE SERVICES, INC.

Table of content: (NPI 1356679252)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356679252 NPI number — IDEAL HOME CARE SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IDEAL 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:
6
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:
1356679252
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/27/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3241 ROUT2 112 BUILDING 7
Provider Second Line Business Mailing Address:
SUITE 5
Provider Business Mailing Address City Name:
MEDFORD
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11763-1424
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-509-5600
Provider Business Mailing Address Fax Number:
631-509-5599

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3241 ROUT2 112 BUILDING 7
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
MEDFORD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11763-1424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-509-5600
Provider Business Practice Location Address Fax Number:
631-509-5599
Provider Enumeration Date:
12/03/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LABORDE
Authorized Official First Name:
MARIE
Authorized Official Middle Name:
NICOLE
Authorized Official Title or Position:
NURSE COORDINATOR
Authorized Official Telephone Number:
631-509-5600

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  1971L001 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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