Healthcare Provider Details

I. General information

NPI: 1962946145
Provider Name (Legal Business Name): DADA HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2016
Last Update Date: 12/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2162 WESTCHESTER AVE
BRONX NY
10462-4754
US

IV. Provider business mailing address

2162 WESTCHESTER AVE
BRONX NY
10462-4754
US

V. Phone/Fax

Practice location:
  • Phone: 347-592-9205
  • Fax:
Mailing address:
  • Phone: 347-592-9205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier111111
Identifier TypeOTHER
Identifier StateND
Identifier IssuerWAITING ON MEDICAID #

VIII. Authorized Official

Name: SYED HAYAT
Title or Position: CEO
Credential:
Phone: 347-281-9255