Provider Demographics
NPI:1477040178
Name:HEARTHSTONE CARE, LLC
Entity Type:Organization
Organization Name:HEARTHSTONE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VITALIY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOBKOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-678-2030
Mailing Address - Street 1:1187 ROUTE 23A # 1A
Mailing Address - Street 2:
Mailing Address - City:CATSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12414-5783
Mailing Address - Country:US
Mailing Address - Phone:518-678-2030
Mailing Address - Fax:518-730-0369
Practice Address - Street 1:1187 ROUTE 23A # 1A
Practice Address - Street 2:
Practice Address - City:CATSKILL
Practice Address - State:NY
Practice Address - Zip Code:12414-5783
Practice Address - Country:US
Practice Address - Phone:518-678-2030
Practice Address - Fax:518-730-0369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-18
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty