Healthcare Provider Details

I. General information

NPI: 1841629698
Provider Name (Legal Business Name): CONSTELLATION HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2013
Last Update Date: 11/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 STAUDERMAN AVE
LYNBROOK NY
11563-2524
US

IV. Provider business mailing address

46 STAUDERMAN AVE
LYNBROOK NY
11563-2524
US

V. Phone/Fax

Practice location:
  • Phone: 516-705-4805
  • Fax: 516-887-8494
Mailing address:
  • Phone: 516-705-4805
  • Fax: 516-887-8494

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: ISAAC STEG
Title or Position: DIRECTOR
Credential:
Phone: 516-705-4805