Provider Demographics
NPI:1396992343
Name:EGAN-HENRY SERVICE CORP
Entity type:Organization
Organization Name:EGAN-HENRY SERVICE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:845-592-1342
Mailing Address - Street 1:8 SOUTH SMITH RD
Mailing Address - Street 2:LAGRANGEVILLE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:12540
Mailing Address - Country:US
Mailing Address - Phone:845-592-1342
Mailing Address - Fax:
Practice Address - Street 1:8 SOUTH SMITH RD
Practice Address - Street 2:LAGRANGEVILLE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:12540
Practice Address - Country:US
Practice Address - Phone:845-592-1342
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2365371163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01348865Medicaid