Healthcare Provider Details

I. General information

NPI: 1588176226
Provider Name (Legal Business Name): CAREMAX PROFESSIONAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2017
Last Update Date: 11/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 WALL ST FL 8
NEW YORK NY
10005-2205
US

IV. Provider business mailing address

30 WALL ST FL 8
NEW YORK NY
10005-2205
US

V. Phone/Fax

Practice location:
  • Phone: 888-653-6655
  • Fax: 888-653-6655
Mailing address:
  • Phone: 888-653-6655
  • Fax: 888-653-6655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MARVENE PHILLIPS
Title or Position: MANAGER
Credential: RN
Phone: 888-653-6655