Healthcare Provider Details

I. General information

NPI: 1073907952
Provider Name (Legal Business Name): REHOBOTH ELDERLY CARE AND COMPANIONSHIP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2015
Last Update Date: 12/25/2023
Certification Date: 12/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2322 GRAND AVE
BALDWIN NY
11510-3169
US

IV. Provider business mailing address

2322 GRAND AVE
BALDWIN NY
11510-3169
US

V. Phone/Fax

Practice location:
  • Phone: 516-719-0761
  • Fax: 516-719-0762
Mailing address:
  • Phone: 516-719-0761
  • Fax: 516-719-0762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: BERTHONY RICHE
Title or Position: CEO/FOUNDER
Credential:
Phone: 516-719-0761