Provider Demographics
NPI:1396385035
Name:DAMEN COMPANION HOME CARE DBN DAMEN AMBULETTE
Entity Type:Organization
Organization Name:DAMEN COMPANION HOME CARE DBN DAMEN AMBULETTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADEJOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:OSOFISAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-747-6167
Mailing Address - Street 1:1792 CARLETON AVE
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-1600
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:699 ACORN ST
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-4235
Practice Address - Country:US
Practice Address - Phone:631-747-6167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAMEN COMPANION HOME CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)