Provider Demographics
NPI:1083997993
Name:EMERALD HEALTH CARE SERVICES
Entity Type:Organization
Organization Name:EMERALD HEALTH CARE SERVICES
Other - Org Name:EMERALD PERSONAL CARE AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:347-300-5858
Mailing Address - Street 1:1102 GATES AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-4304
Mailing Address - Country:US
Mailing Address - Phone:347-300-5858
Mailing Address - Fax:212-202-4051
Practice Address - Street 1:1102 GATES AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11221-4304
Practice Address - Country:US
Practice Address - Phone:347-300-5858
Practice Address - Fax:212-202-4051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY526438253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care