Provider Demographics
NPI:1689919581
Name:NEW HAVEN HOME CARE
Entity Type:Organization
Organization Name:NEW HAVEN HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAVOUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-730-4342
Mailing Address - Street 1:1526 NEW HAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-5148
Mailing Address - Country:US
Mailing Address - Phone:646-730-4342
Mailing Address - Fax:718-471-7650
Practice Address - Street 1:1526 NEW HAVEN AVE
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-5148
Practice Address - Country:US
Practice Address - Phone:646-730-4342
Practice Address - Fax:718-471-7650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0557L001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health