Provider Demographics
NPI:1457846602
Name:ABC HOME CARE SUPPLIES
Entity Type:Organization
Organization Name:ABC HOME CARE SUPPLIES
Other - Org Name:ABC HOME CARE AGENCY INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AKEESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-273-0762
Mailing Address - Street 1:12 CLARKE ST
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-2002
Mailing Address - Country:US
Mailing Address - Phone:631-273-0762
Mailing Address - Fax:631-273-0762
Practice Address - Street 1:12 CLARKE STREET
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-2002
Practice Address - Country:US
Practice Address - Phone:631-273-0762
Practice Address - Fax:631-273-0762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04674246Medicaid