Provider Demographics
NPI:1790030070
Name:KARTUSHKA HOME CARE
Entity Type:Organization
Organization Name:KARTUSHKA HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KERLANDE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAZARD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:631-228-4072
Mailing Address - Street 1:3547 GREAT NECK RD APT 77D
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-4306
Mailing Address - Country:US
Mailing Address - Phone:631-228-4072
Mailing Address - Fax:
Practice Address - Street 1:3547 GREAT NECK RD APT 77D
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-4306
Practice Address - Country:US
Practice Address - Phone:631-228-4072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY417241311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home