Healthcare Provider Details

I. General information

NPI: 1114540333
Provider Name (Legal Business Name): CITY HOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2020
Last Update Date: 05/21/2020
Certification Date: 05/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16902 HIGHLAND AVE FL 1
JAMAICA NY
11432-2632
US

IV. Provider business mailing address

8450 169TH ST APT 415
JAMAICA NY
11432-2016
US

V. Phone/Fax

Practice location:
  • Phone: 718-314-6763
  • Fax: 347-923-3217
Mailing address:
  • Phone: 718-314-6763
  • Fax: 347-923-3217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. IMRUL KABIR
Title or Position: OWNER
Credential: DPT
Phone: 718-314-6763