Provider Demographics
NPI:1558804955
Name:DETTY HOME CARE SERVICE
Entity Type:Organization
Organization Name:DETTY HOME CARE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PATIENT SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:JEAN-LOUIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:646-474-6238
Mailing Address - Street 1:13935 228TH ST
Mailing Address - Street 2:
Mailing Address - City:LAURELTON
Mailing Address - State:NY
Mailing Address - Zip Code:11413-2946
Mailing Address - Country:US
Mailing Address - Phone:646-474-6238
Mailing Address - Fax:718-514-6712
Practice Address - Street 1:13935 228TH ST
Practice Address - Street 2:
Practice Address - City:LAURELTON
Practice Address - State:NY
Practice Address - Zip Code:11413-2946
Practice Address - Country:US
Practice Address - Phone:646-474-6238
Practice Address - Fax:718-514-6712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-02
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1828L001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health