Provider Demographics
NPI:1912553967
Name:SUPPORTIVE HOME CARE LLC
Entity Type:Organization
Organization Name:SUPPORTIVE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MAX
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-627-7050
Mailing Address - Street 1:198 FOSTER AVE STE B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-2134
Mailing Address - Country:US
Mailing Address - Phone:718-627-7050
Mailing Address - Fax:
Practice Address - Street 1:198 FOSTER AVE STE B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-2134
Practice Address - Country:US
Practice Address - Phone:718-627-7050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health