Healthcare Provider Details

I. General information

NPI: 1023510252
Provider Name (Legal Business Name): HEARTHSTONE GENTLE CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2018
Last Update Date: 07/16/2020
Certification Date: 07/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1187 ROUTE 23A # 23A
CATSKILL NY
12414-5650
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 518-303-2224
  • Fax:
Mailing address:
  • Phone: 518-303-2224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: VITALIY BOBKOV
Title or Position: PRESIDENT
Credential:
Phone: 518-303-2224