Healthcare Provider Details

I. General information

NPI: 1215925243
Provider Name (Legal Business Name): LIVING RESOURCES HOME CARE AGENCY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 02/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 WASHINGTON AVENUE EXT
ALBANY NY
12203-7303
US

IV. Provider business mailing address

300 WASHINGTON AVENUE EXT
ALBANY NY
12203-7303
US

V. Phone/Fax

Practice location:
  • Phone: 518-218-0000
  • Fax: 518-867-8704
Mailing address:
  • Phone: 518-218-0000
  • Fax: 518-867-8704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number0743L002
License Number StateNY

VIII. Authorized Official

Name: MR. FREDRICK W ERLICH
Title or Position: CEO
Credential:
Phone: 518-218-0000