Provider Demographics
NPI:1114967924
Name:HOME AIDE SERVICE OF EASTERN NEW YORK, INC.
Entity Type:Organization
Organization Name:HOME AIDE SERVICE OF EASTERN NEW YORK, INC.
Other - Org Name:EDDY VISITING NURSE ASSOCIATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:T
Authorized Official - Last Name:MAZZACCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-270-1310
Mailing Address - Street 1:433 RIVER ST
Mailing Address - Street 2:SUITE 3000
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-2238
Mailing Address - Country:US
Mailing Address - Phone:518-274-6200
Mailing Address - Fax:518-274-1829
Practice Address - Street 1:433 RIVER ST
Practice Address - Street 2:SUITE 3000
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-2238
Practice Address - Country:US
Practice Address - Phone:518-274-6200
Practice Address - Fax:518-274-1829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1921601251E00000X
NY1921901L251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000400078000OtherBSNENY, SR BLUE
NY10002765OtherCDPHP
NY7408289OtherAETNA
NY004116OtherEMPIRE BC
NY990069OtherMVP
NY00872739Medicaid
NY3503OtherGHI
NY040401000507OtherFIDELIS
NY00896511Medicaid
NY702486OtherHARVARD PILGRIM
NY=========OtherTRICARE
NY702486OtherHARVARD PILGRIM
NY=========OtherUHC-HCAP
NY=========OtherWELLCARE
NY00872739Medicaid