Provider Demographics
NPI:1083098768
Name:FIVE BOROUGH HOME CARE, INC
Entity Type:Organization
Organization Name:FIVE BOROUGH HOME CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:YURI
Authorized Official - Middle Name:
Authorized Official - Last Name:ROZENBLYUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-758-5670
Mailing Address - Street 1:1893 CONEY ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-6512
Mailing Address - Country:US
Mailing Address - Phone:718-758-5670
Mailing Address - Fax:866-270-0585
Practice Address - Street 1:1893 CONEY ISLAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-6512
Practice Address - Country:US
Practice Address - Phone:718-758-5670
Practice Address - Fax:866-270-0585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1668L001253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1668L001OtherLHCSA