Healthcare Provider Details

I. General information

NPI: 1639411697
Provider Name (Legal Business Name): PERSONAL TOUCH HOME CARE IPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2013
Last Update Date: 03/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22215 NORTHERN BLVD
BAYSIDE NY
11361-3678
US

IV. Provider business mailing address

22215 NORTHERN BLVD
BAYSIDE NY
11361-3678
US

V. Phone/Fax

Practice location:
  • Phone: 718-468-4747
  • Fax: 718-264-5834
Mailing address:
  • Phone: 718-468-4747
  • Fax: 718-264-5834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: LORIGAY LASKIN
Title or Position: CONTRACT MANAGER
Credential:
Phone: 718-468-4747