Healthcare Provider Details

I. General information

NPI: 1174147425
Provider Name (Legal Business Name): TAYLOR MADE HOMECARE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2020
Last Update Date: 06/02/2020
Certification Date: 06/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1389 HEMPSTEAD TPKE
ELMONT NY
11003-2546
US

IV. Provider business mailing address

1389 HEMPSTEAD TPKE
ELMONT NY
11003-2546
US

V. Phone/Fax

Practice location:
  • Phone: 516-744-6161
  • Fax: 516-744-6160
Mailing address:
  • Phone: 516-744-6161
  • Fax: 516-775-6160

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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MS. KATRINA L BAKER
Title or Position: OWNER
Credential:
Phone: 516-744-6161