Healthcare Provider Details

I. General information

NPI: 1073971032
Provider Name (Legal Business Name): HEARTHSTONE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2016
Last Update Date: 02/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1187 ROUTE 23A
CATSKILL NY
12414-5650
US

IV. Provider business mailing address

1187 ROUTE 23A
CATSKILL NY
12414-5650
US

V. Phone/Fax

Practice location:
  • Phone: 718-934-6714
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DMITRIY BOBKOV
Title or Position: PRESIDENT
Credential:
Phone: 718-934-6714