Healthcare Provider Details

I. General information

NPI: 1811074362
Provider Name (Legal Business Name): TREMONT COMMUNITY COUNCIL HOME ATTENDANT PROGRAM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 WATERS PL SUITE 106
BRONX NY
10461-2728
US

IV. Provider business mailing address

1200 WATERS PL SUITE 106
BRONX NY
10461-2728
US

V. Phone/Fax

Practice location:
  • Phone: 718-239-0608
  • Fax: 718-239-1323
Mailing address:
  • Phone: 718-239-0608
  • Fax: 718-239-1323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number9626L001
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number9626L001
License Number StateNY

VIII. Authorized Official

Name: MR. O'DELL HOLLAND
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 718-239-0608