Healthcare Provider Details

I. General information

NPI: 1396744074
Provider Name (Legal Business Name): CHS HOME SUPPORT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 10/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 POWER DR
HAUPPAUGE NY
11788-4229
US

IV. Provider business mailing address

15 POWER DR
HAUPPAUGE NY
11788-4229
US

V. Phone/Fax

Practice location:
  • Phone: 631-940-3350
  • Fax: 631-940-3405
Mailing address:
  • Phone: 631-940-3350
  • Fax: 631-940-3405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number025107
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNY

VIII. Authorized Official

Name: MS. GARNET GAY HUGHES
Title or Position: DIR OF SECURITY, PRIVACY, COMPLIANC
Credential: RN
Phone: 631-940-3350