Healthcare Provider Details

I. General information

NPI: 1417458605
Provider Name (Legal Business Name): CAMBRIDGE HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2018
Last Update Date: 02/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 MADISON AVE STE 1415
NEW YORK NY
10017-1111
US

IV. Provider business mailing address

415 MADISON AVE STE 1415
NEW YORK NY
10017-1111
US

V. Phone/Fax

Practice location:
  • Phone: 646-673-8415
  • Fax: 646-349-2017
Mailing address:
  • Phone: 646-673-8415
  • Fax: 646-349-2017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number2131L001
License Number StateNY

VIII. Authorized Official

Name: MRS. LORNA ELSA MCDONALD
Title or Position: PRESIDENT
Credential: RN
Phone: 646-673-8415