Healthcare Provider Details

I. General information

NPI: 1093747214
Provider Name (Legal Business Name): OLOM HOME CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 10/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 9TH AVE 14TH FLOOR
NEW YORK NY
10001-1620
US

IV. Provider business mailing address

6323 7TH AVE
BROOKLYN NY
11220-4742
US

V. Phone/Fax

Practice location:
  • Phone: 212-356-5343
  • Fax: 212-356-5420
Mailing address:
  • Phone: 718-630-2510
  • Fax: 718-759-4291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number5902610
License Number StateNY

VIII. Authorized Official

Name: ALEXANDER BALKO
Title or Position: SR./VP CHIEF FINANCIAL OFFICER
Credential:
Phone: 718-491-7221