Provider Demographics
NPI:1417497785
Name:PEREGRINE HOMECARE
Entity Type:Organization
Organization Name:PEREGRINE HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KALET-CLARE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:315-685-5170
Mailing Address - Street 1:1551 EAST GENESEE STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SKANEATELES
Mailing Address - State:NY
Mailing Address - Zip Code:13152
Mailing Address - Country:US
Mailing Address - Phone:315-685-5170
Mailing Address - Fax:315-685-5186
Practice Address - Street 1:1551 EAST GENESEE STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:SKANEATELES
Practice Address - State:NY
Practice Address - Zip Code:13152-8879
Practice Address - Country:US
Practice Address - Phone:315-685-5170
Practice Address - Fax:315-685-5186
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEREGRINE HOMECARE STRATEGIES OF NEW YORK, LLC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1509L001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health