Provider Demographics
NPI:1093747214
Name:OLOM HOME CARE, INC.
Entity Type:Organization
Organization Name:OLOM HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR./VP CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:BALKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-491-7221
Mailing Address - Street 1:6323 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-4742
Mailing Address - Country:US
Mailing Address - Phone:718-630-2510
Mailing Address - Fax:718-759-4291
Practice Address - Street 1:440 9TH AVE
Practice Address - Street 2:14TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-1620
Practice Address - Country:US
Practice Address - Phone:212-356-5343
Practice Address - Fax:212-356-5420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5902610251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02228971Medicaid
NY337274Medicare ID - Type Unspecified