Provider Demographics
NPI:1396744074
Name:CHS HOME SUPPORT SERVICES
Entity type:Organization
Organization Name:CHS HOME SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR OF SECURITY, PRIVACY, COMPLIANC
Authorized Official - Prefix:MS
Authorized Official - First Name:GARNET
Authorized Official - Middle Name:GAY
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:631-940-3350
Mailing Address - Street 1:15 POWER DR
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-4229
Mailing Address - Country:US
Mailing Address - Phone:631-940-3350
Mailing Address - Fax:631-940-3405
Practice Address - Street 1:15 POWER DR
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-4229
Practice Address - Country:US
Practice Address - Phone:631-940-3350
Practice Address - Fax:631-940-3405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-15
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025107251F00000X
NY332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No251F00000XAgenciesHome Infusion
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02205392Medicaid
NY4261390001Medicare ID - Type UnspecifiedMEDICARE PROVIDER #