Provider Demographics
NPI:1356093801
Name:ESSENTIALS HOME CARE LLC
Entity Type:Organization
Organization Name:ESSENTIALS HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RENATA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-864-0977
Mailing Address - Street 1:2327 MILL AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-6433
Mailing Address - Country:US
Mailing Address - Phone:718-864-0977
Mailing Address - Fax:
Practice Address - Street 1:1423 CHAPEL ST FL 3
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4411
Practice Address - Country:US
Practice Address - Phone:718-864-0977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care