Healthcare Provider Details

I. General information

NPI: 1821281718
Provider Name (Legal Business Name): CROWNE OF LIFE CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2007
Last Update Date: 03/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4626 NEW UTRECHT AVE
BROOKLYN NY
11219-2553
US

IV. Provider business mailing address

4626 NEW UTRECHT AVE
BROOKLYN NY
11219-2553
US

V. Phone/Fax

Practice location:
  • Phone: 718-475-2333
  • Fax: 718-475-2323
Mailing address:
  • Phone: 718-475-2333
  • Fax: 718-475-2323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1180L001
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number02812628
License Number StateNY

VIII. Authorized Official

Name: MARTINE C WALKER
Title or Position: ADMINISTRATOR
Credential:
Phone: 718-475-2333