Healthcare Provider Details

I. General information

NPI: 1477040178
Provider Name (Legal Business Name): HEARTHSTONE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2018
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1187 ROUTE 23A # 1A
CATSKILL NY
12414-5783
US

IV. Provider business mailing address

1187 ROUTE 23A # 1A
CATSKILL NY
12414-5783
US

V. Phone/Fax

Practice location:
  • Phone: 518-678-2030
  • Fax: 518-730-0369
Mailing address:
  • Phone: 518-678-2030
  • Fax: 518-730-0369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: VITALIY BOBKOV
Title or Position: PRESIDENT
Credential:
Phone: 518-678-2030