Provider Demographics
NPI:1710086475
Name:PALLIATIVE HOME CARE OF NIAGARA, INC.
Entity Type:Organization
Organization Name:PALLIATIVE HOME CARE OF NIAGARA, INC.
Other - Org Name:LIBERTY HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:LOMEO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-439-4417
Mailing Address - Street 1:2186 LIBERTY DR
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-3727
Mailing Address - Country:US
Mailing Address - Phone:716-215-2085
Mailing Address - Fax:716-283-4589
Practice Address - Street 1:2186 LIBERTY DR
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-3727
Practice Address - Country:US
Practice Address - Phone:716-215-2085
Practice Address - Fax:716-283-4589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1115L001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA1389Medicare PIN
NY4297530001Medicare ID - Type UnspecifiedPROVIDER #