Provider Demographics
NPI:1740996206
Name:ETTERAM HOME CARE LLC
Entity type:Organization
Organization Name:ETTERAM HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EXCHING-CHINELLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARETTE JOSUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-452-6223
Mailing Address - Street 1:92 EMPRESS PINES DR
Mailing Address - Street 2:
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-3130
Mailing Address - Country:US
Mailing Address - Phone:631-452-6223
Mailing Address - Fax:
Practice Address - Street 1:1110 NW 136TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33168-6733
Practice Address - Country:US
Practice Address - Phone:631-452-6223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-27
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care