Provider Demographics
NPI:1164853321
Name:PLATINUM HOME HEATLH CARE
Entity Type:Organization
Organization Name:PLATINUM HOME HEATLH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BREIHOF
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:845-482-2238
Mailing Address - Street 1:PO BOX 136
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12748-0136
Mailing Address - Country:US
Mailing Address - Phone:845-482-2238
Mailing Address - Fax:
Practice Address - Street 1:63 JEFFERSON AVE.
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:NY
Practice Address - Zip Code:12748
Practice Address - Country:US
Practice Address - Phone:845-482-2238
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY416454302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization