Provider Demographics
NPI:1164975918
Name:EP HOME CARE LLC
Entity Type:Organization
Organization Name:EP HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULETT
Authorized Official - Middle Name:N
Authorized Official - Last Name:HARRIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-629-2112
Mailing Address - Street 1:2350 RALPH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-5515
Mailing Address - Country:US
Mailing Address - Phone:718-629-2112
Mailing Address - Fax:718-629-2113
Practice Address - Street 1:2350 RALPH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5515
Practice Address - Country:US
Practice Address - Phone:718-629-2112
Practice Address - Fax:718-629-2113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-28
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2094-L251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04247729Medicaid