Healthcare Provider Details

I. General information

NPI: 1518328939
Provider Name (Legal Business Name): HERON HOME AND HEALTH CARE PERSONNEL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2016
Last Update Date: 03/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16830 89TH AVE
JAMAICA NY
11432-4446
US

IV. Provider business mailing address

16830 89TH AVE
JAMAICA NY
11432-4446
US

V. Phone/Fax

Practice location:
  • Phone: 718-291-8788
  • Fax: 718-291-8852
Mailing address:
  • Phone: 718-291-8788
  • Fax: 718-291-8852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number0832319-DCA
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number0832319-DCA
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number0832319-DCA
License Number StateNY

VIII. Authorized Official

Name: YVONNE FIGUEROA
Title or Position: DIRECTOR
Credential:
Phone: 718-291-8788