Healthcare Provider Details

I. General information

NPI: 1356679252
Provider Name (Legal Business Name): IDEAL HOME CARE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2009
Last Update Date: 08/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3241 ROUT2 112 BUILDING 7 SUITE 5
MEDFORD NY
11763-1424
US

IV. Provider business mailing address

3241 ROUT2 112 BUILDING 7 SUITE 5
MEDFORD NY
11763-1424
US

V. Phone/Fax

Practice location:
  • Phone: 631-509-5600
  • Fax: 631-509-5599
Mailing address:
  • Phone: 631-509-5600
  • Fax: 631-509-5599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1971L001
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARIE NICOLE LABORDE
Title or Position: NURSE COORDINATOR
Credential: RN
Phone: 631-509-5600