Provider Demographics
NPI:1871635987
Name:HOME CARE AT ITS BEST
Entity Type:Organization
Organization Name:HOME CARE AT ITS BEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KETTLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DERIVAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-204-5518
Mailing Address - Street 1:22121 JAMAICA AVE
Mailing Address - Street 2:2ND FL
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11428-2015
Mailing Address - Country:US
Mailing Address - Phone:718-468-6923
Mailing Address - Fax:718-468-6925
Practice Address - Street 1:22121 JAMAICA AVE
Practice Address - Street 2:2ND FL
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11428-2015
Practice Address - Country:US
Practice Address - Phone:718-468-6923
Practice Address - Fax:718-468-6925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC693L001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02054231Medicaid