Healthcare Provider Details

I. General information

NPI: 1225190150
Provider Name (Legal Business Name): HILLSIDE HEALTH CARE R.N., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 08/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 OSBORNE HILL RD
FISHKILL NY
12524-2519
US

IV. Provider business mailing address

260 OSBORNE HILL RD
FISHKILL NY
12524-2519
US

V. Phone/Fax

Practice location:
  • Phone: 845-440-3940
  • Fax:
Mailing address:
  • Phone: 845-440-3940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number443900-1
License Number StateNY

VIII. Authorized Official

Name: MRS. BRENDA JOYCE ARDREY
Title or Position: PRESIDENT
Credential: R.N.
Phone: 845-440-3940