Healthcare Provider Details

I. General information

NPI: 1740725126
Provider Name (Legal Business Name): SMILE HOMECARE AGENCY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2016
Last Update Date: 10/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 BRIGHTON 1ST PL FL 2
BROOKLYN NY
11235-7415
US

IV. Provider business mailing address

86 BRIGHTON 1ST PL FL 2
BROOKLYN NY
11235-7415
US

V. Phone/Fax

Practice location:
  • Phone: 917-420-0301
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number2664L001
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ELLEN VERNY
Title or Position: PRESIDENT
Credential:
Phone: 718-484-7307