Provider Demographics
NPI:1710306329
Name:CITY HOME CARE, LLC
Entity Type:Organization
Organization Name:CITY HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:I
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARGORODSKIY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-823-3090
Mailing Address - Street 1:90 OAK ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:NEWTON UPPER FALLS
Mailing Address - State:MA
Mailing Address - Zip Code:02464-1439
Mailing Address - Country:US
Mailing Address - Phone:617-964-2489
Mailing Address - Fax:
Practice Address - Street 1:90 OAK ST
Practice Address - Street 2:SUITE 402
Practice Address - City:NEWTON UPPER FALLS
Practice Address - State:MA
Practice Address - Zip Code:02464-1439
Practice Address - Country:US
Practice Address - Phone:617-964-2489
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA110092840B251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110092840BMedicaid