Healthcare Provider Details

I. General information

NPI: 1104117373
Provider Name (Legal Business Name): BALM OF GILEAD CERTIFIED HOME CARE AGENCY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2011
Last Update Date: 04/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4626 WHITE PLAINS RD
BRONX NY
10470-1610
US

IV. Provider business mailing address

4626 WHITE PLAINS RD
BRONX NY
10470-1610
US

V. Phone/Fax

Practice location:
  • Phone: 718-944-1776
  • Fax: 718-944-1779
Mailing address:
  • Phone: 718-944-1776
  • Fax: 718-944-1779

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: DR. GREGORY EMILI
Title or Position: CEO
Credential: M.D
Phone: 718-944-1776