1538371778 NPI number — WHITE GLOVE COMMUNITY CARE, INC.

Table of content: (NPI 1538371778)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538371778 NPI number — WHITE GLOVE COMMUNITY CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WHITE GLOVE COMMUNITY CARE, 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:
1538371778
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/31/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
89 BARTLETT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11206-4463
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-828-2666
Provider Business Mailing Address Fax Number:
718-782-1538

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1470 ROUTE 88
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRICK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08724-2368
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
844-828-2666
Provider Business Practice Location Address Fax Number:
718-782-1538
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BECK
Authorized Official First Name:
BLIMA
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER, CONTRACTS
Authorized Official Telephone Number:
718-828-2666

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: 9839L001 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 252Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X , with the licence number: 9839L001 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X , with the licence number: HP0264700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 04244515 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01718294 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 03480779 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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