Healthcare Provider Details

I. General information

NPI: 1417788985
Provider Name (Legal Business Name): VELVET OAK HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2024
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CARVER LOOP APT 13G
BRONX NY
10475-2934
US

IV. Provider business mailing address

100 CARVER LOOP APT 13G
BRONX NY
10475-2934
US

V. Phone/Fax

Practice location:
  • Phone: 570-269-9989
  • Fax:
Mailing address:
  • Phone: 570-269-9989
  • Fax:

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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: DASHAWN G MCKENZIE
Title or Position: CEO
Credential:
Phone: 570-269-9989