Provider Demographics
NPI:1760972277
Name:EMINENCE HOME CARE LLC
Entity Type:Organization
Organization Name:EMINENCE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAFIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-805-0702
Mailing Address - Street 1:1000 GATES AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-6296
Mailing Address - Country:US
Mailing Address - Phone:917-805-0702
Mailing Address - Fax:718-280-1050
Practice Address - Street 1:32541 CHESTNUT ST
Practice Address - Street 2:#800
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19038
Practice Address - Country:US
Practice Address - Phone:347-645-3969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-10
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA37393601OtherHOME CARE AGENCY LICENSE