Provider Demographics
NPI:1801498100
Name:BOOM CARE LLC
Entity type:Organization
Organization Name:BOOM CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:MR
Authorized Official - First Name:M
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-528-0890
Mailing Address - Street 1:30 S 17TH ST FL 13
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-4001
Mailing Address - Country:US
Mailing Address - Phone:347-528-0890
Mailing Address - Fax:
Practice Address - Street 1:30 S 17TH ST FL 13
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-4001
Practice Address - Country:US
Practice Address - Phone:347-528-0890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health