Provider Demographics
NPI:1114266962
Name:TRI-BOROUGH CERTIFIED HEALTH SYSTEMS OF NEW YORK. LLC
Entity Type:Organization
Organization Name:TRI-BOROUGH CERTIFIED HEALTH SYSTEMS OF NEW YORK. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:CORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-282-7619
Mailing Address - Street 1:50 CLINTON ST STE 601
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-4282
Mailing Address - Country:US
Mailing Address - Phone:516-932-7799
Mailing Address - Fax:516-932-1415
Practice Address - Street 1:50 CLINTON ST STE 601
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-4282
Practice Address - Country:US
Practice Address - Phone:516-932-7799
Practice Address - Fax:516-932-1415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-13
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01053983Medicaid
NY01659690Medicaid
NY01053983Medicaid