Provider Demographics
NPI:1093998072
Name:GOODCARE HOME HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:GOODCARE HOME HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:VALERY
Authorized Official - Middle Name:P
Authorized Official - Last Name:SANDYREV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-833-3445
Mailing Address - Street 1:1330 NIAGARA FALLS BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-8900
Mailing Address - Country:US
Mailing Address - Phone:716-833-3445
Mailing Address - Fax:716-407-0625
Practice Address - Street 1:1330 NIAGARA FALLS BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-8900
Practice Address - Country:US
Practice Address - Phone:716-833-3445
Practice Address - Fax:716-407-0625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1068L001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02656417Medicaid