Healthcare Provider Details

I. General information

NPI: 1114882594
Provider Name (Legal Business Name): FOUR BROTHERS HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5488 S CEYLON WAY
CENTENNIAL CO
80015-4832
US

IV. Provider business mailing address

5488 S CEYLON WAY
CENTENNIAL CO
80015-4832
US

V. Phone/Fax

Practice location:
  • Phone: 646-384-3691
  • Fax:
Mailing address:
  • Phone: 646-384-3691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN BOROHOV
Title or Position: MEMBER
Credential:
Phone: 646-384-3691