Provider Demographics
NPI:1336293232
Name:LONG ISLAND CARE AT HOME LTD
Entity Type:Organization
Organization Name:LONG ISLAND CARE AT HOME LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V PRES
Authorized Official - Prefix:
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:C
Authorized Official - Last Name:OSBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-794-0700
Mailing Address - Street 1:1400 OLD COUNTRY ROAD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-5119
Mailing Address - Country:US
Mailing Address - Phone:516-794-0700
Mailing Address - Fax:516-794-0787
Practice Address - Street 1:1400 OLD COUNTRY ROAD
Practice Address - Street 2:SUITE 108
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-5119
Practice Address - Country:US
Practice Address - Phone:516-794-0700
Practice Address - Fax:516-794-0787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9376L001251E00000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered251E00000XAgenciesHome HealthGroup - Single Specialty
Not Answered374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01444357Medicaid