Provider Demographics
NPI:1619090784
Name:HOMECARE SERVICES FOR IND. LIVING
Entity Type:Organization
Organization Name:HOMECARE SERVICES FOR IND. LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:V
Authorized Official - Last Name:CONFIDENT
Authorized Official - Suffix:
Authorized Official - Credentials:BSNMHSMA RN
Authorized Official - Phone:718-627-1150
Mailing Address - Street 1:2044 OCEAN AVE
Mailing Address - Street 2:SUITE-B4
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-7328
Mailing Address - Country:US
Mailing Address - Phone:718-627-1150
Mailing Address - Fax:718-627-2165
Practice Address - Street 1:2044 OCEAN AVE
Practice Address - Street 2:SUITE-B4
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-7328
Practice Address - Country:US
Practice Address - Phone:718-627-1150
Practice Address - Fax:718-627-2165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9988L001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00921068Medicaid