Healthcare Provider Details

I. General information

NPI: 1497733562
Provider Name (Legal Business Name): ULSTER HOME HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 09/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

918 ULSTER AVE
KINGSTON NY
12401-1344
US

IV. Provider business mailing address

PO BOX 1850
KINGSTON NY
12402-1850
US

V. Phone/Fax

Practice location:
  • Phone: 845-339-6683
  • Fax: 845-339-7863
Mailing address:
  • Phone: 845-339-6683
  • Fax: 845-339-7863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number01078679
License Number StateNY

VIII. Authorized Official

Name: MS. SUSAN C KOPPENHAVER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MPH
Phone: 845-339-6683