Provider Demographics
NPI:1821281718
Name:CROWNE OF LIFE CARE, INC.
Entity Type:Organization
Organization Name:CROWNE OF LIFE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARTINE
Authorized Official - Middle Name:C
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-475-2333
Mailing Address - Street 1:4626 NEW UTRECHT AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-2553
Mailing Address - Country:US
Mailing Address - Phone:718-475-2333
Mailing Address - Fax:718-475-2323
Practice Address - Street 1:4626 NEW UTRECHT AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2553
Practice Address - Country:US
Practice Address - Phone:718-475-2333
Practice Address - Fax:718-475-2323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1180L001251E00000X
NY02812628251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02812628Medicaid