Provider Demographics
NPI:1336684604
Name:IDEAL HOME CARE STAFFING LLC
Entity Type:Organization
Organization Name:IDEAL HOME CARE STAFFING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:LABORDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-509-5600
Mailing Address - Street 1:3241 ROUTE 112
Mailing Address - Street 2:BUILDING 7 SUITE 5
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-1434
Mailing Address - Country:US
Mailing Address - Phone:631-509-5600
Mailing Address - Fax:
Practice Address - Street 1:3241 ROUTE 112
Practice Address - Street 2:BUILDING 7 SUITE 5
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-1434
Practice Address - Country:US
Practice Address - Phone:631-509-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-22
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health