Provider Demographics
NPI:1679561161
Name:LIVING RESOURCES CERTIFIED HOME HEALTH AGENCY, INC.
Entity Type:Organization
Organization Name:LIVING RESOURCES CERTIFIED HOME HEALTH AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL OPERATIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CARLENE
Authorized Official - Middle Name:S
Authorized Official - Last Name:DORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-218-0000
Mailing Address - Street 1:300 WASHINGTON AVENUE EXT
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-4403
Mailing Address - Country:US
Mailing Address - Phone:518-867-8800
Mailing Address - Fax:518-867-8711
Practice Address - Street 1:300 WASHINGTON AVENUE EXT
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-4403
Practice Address - Country:US
Practice Address - Phone:518-867-8800
Practice Address - Fax:518-867-8711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4601604251E00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY100-28600OtherPRIVATE INSURANCE ID
NY02068968Medicaid
NY02068968Medicaid