Provider Demographics
NPI:1114540333
Name:CITY HOMECARE LLC
Entity Type:Organization
Organization Name:CITY HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IMRUL
Authorized Official - Middle Name:
Authorized Official - Last Name:KABIR
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:718-314-6763
Mailing Address - Street 1:8450 169TH ST APT 415
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-2016
Mailing Address - Country:US
Mailing Address - Phone:718-314-6763
Mailing Address - Fax:347-923-3217
Practice Address - Street 1:16902 HIGHLAND AVE FL 1
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-2632
Practice Address - Country:US
Practice Address - Phone:718-314-6763
Practice Address - Fax:347-923-3217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-21
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03427938Medicaid