Provider Demographics
NPI:1104391853
Name:HOMETECH REHAB
Entity Type:Organization
Organization Name:HOMETECH REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GIGA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMBASHIDZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-379-0072
Mailing Address - Street 1:1556 W 8TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-6503
Mailing Address - Country:US
Mailing Address - Phone:646-379-0072
Mailing Address - Fax:
Practice Address - Street 1:1556 W 8TH ST APT 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-6503
Practice Address - Country:US
Practice Address - Phone:646-379-0072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health