Healthcare Provider Details

I. General information

NPI: 1548582513
Provider Name (Legal Business Name): FULL SERVICE HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2010
Last Update Date: 02/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4517 MONTICELLO AVE
BRONX NY
10466-1029
US

IV. Provider business mailing address

4517 MONTICELLO AVE
BRONX NY
10466-1029
US

V. Phone/Fax

Practice location:
  • Phone: 917-447-6211
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DARLENE LAROSE
Title or Position: PRESIDENT
Credential:
Phone: 917-447-6211