Provider Demographics
NPI: | 1710522867 |
---|---|
Name: | NYC PRO HOME CARE INC |
Entity Type: | Organization |
Organization Name: | NYC PRO HOME CARE INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | ADMINISTRATOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JOSE |
Authorized Official - Middle Name: | RICARDO |
Authorized Official - Last Name: | DIAZ |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | M ED |
Authorized Official - Phone: | 718-713-7041 |
Mailing Address - Street 1: | 2102 AVENUE Z STE 304 |
Mailing Address - Street 2: | |
Mailing Address - City: | BROOKLYN |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 11235-2812 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 718-713-7041 |
Mailing Address - Fax: | 347-779-0433 |
Practice Address - Street 1: | 2102 AVENUE Z STE 304 |
Practice Address - Street 2: | |
Practice Address - City: | BROOKLYN |
Practice Address - State: | NY |
Practice Address - Zip Code: | 11235-2812 |
Practice Address - Country: | US |
Practice Address - Phone: | 718-713-7041 |
Practice Address - Fax: | 347-779-0433 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2019-11-13 |
Last Update Date: | 2021-02-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 374U00000X | Nursing Service Related Providers | Home Health Aide | Group - Single Specialty | |
No | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | Group - Single Specialty | |
No | 133V00000X | Dietary & Nutritional Service Providers | Dietitian, Registered | Group - Single Specialty | |
No | 163W00000X | Nursing Service Providers | Registered Nurse | Group - Single Specialty | |
No | 163WG0000X | Nursing Service Providers | Registered Nurse | General Practice | Group - Single Specialty |
No | 163WP0200X | Nursing Service Providers | Registered Nurse | Pediatrics | Group - Single Specialty |
No | 224Z00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | Group - Single Specialty | |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Single Specialty | |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Single Specialty | |
No | 227800000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Certified | Group - Single Specialty | |
No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Single Specialty | |
No | 253Z00000X | Agencies | In Home Supportive Care | ||
No | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies | Group - Single Specialty | |
No | 347E00000X | Transportation Services | Transportation Broker | Group - Single Specialty | |
No | 376J00000X | Nursing Service Related Providers | Homemaker | Group - Single Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NY | 06323362 | Medicaid |