Provider Demographics
NPI:1598054512
Name:COMPLETE HOME CARE SERVICE
Entity Type:Organization
Organization Name:COMPLETE HOME CARE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS-JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-337-3746
Mailing Address - Street 1:2916 FALCON AVE
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-1845
Mailing Address - Country:US
Mailing Address - Phone:718-337-3746
Mailing Address - Fax:
Practice Address - Street 1:2916 FALCON AVE
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-1845
Practice Address - Country:US
Practice Address - Phone:718-337-3746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304366251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health