Healthcare Provider Details

I. General information

NPI: 1821210410
Provider Name (Legal Business Name): PRIDECARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 01/07/2020
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 SKYLINE DR STE 225
HAWTHORNE NY
10532-2164
US

IV. Provider business mailing address

7 SKYLINE DR STE 225
HAWTHORNE NY
10532-2164
US

V. Phone/Fax

Practice location:
  • Phone: 914-579-2250
  • Fax: 914-579-2255
Mailing address:
  • Phone: 914-579-2250
  • Fax: 914-579-2255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number0634L002
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. RAYMOND MIRRA
Title or Position: PRESIDENT
Credential:
Phone: 484-494-3121