Healthcare Provider Details

I. General information

NPI: 1801337993
Provider Name (Legal Business Name): INTERIM HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2017
Last Update Date: 03/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 DELAWARE AVE SUITE 1200
BUFFALO NY
14202
US

IV. Provider business mailing address

69 DELAWARE AVE SUITE 1200
BUFFALO NY
14202-3812
US

V. Phone/Fax

Practice location:
  • Phone: 716-852-5900
  • Fax: 716-852-5913
Mailing address:
  • Phone: 716-852-5900
  • Fax: 716-852-5913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number5215001
License Number StateNY

VIII. Authorized Official

Name: MRS. PATRICIA PORTER
Title or Position: REGISTERED NURSE
Credential: RN
Phone: 716-510-1269