Healthcare Provider Details

I. General information

NPI: 1104397322
Provider Name (Legal Business Name): CIVILITY HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 MAIN STREET, STE 104
BREWSTER NY
10509
US

IV. Provider business mailing address

155 MAIN STREET, STE 104
BREWSTER NY
10509
US

V. Phone/Fax

Practice location:
  • Phone: 845-278-1727
  • Fax: 845-278-1930
Mailing address:
  • Phone: 845-278-1727
  • Fax: 845-278-1930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DARYN CLARK
Title or Position: MANAGING MEMBER
Credential:
Phone: 203-942-3677