Healthcare Provider Details

I. General information

NPI: 1780934679
Provider Name (Legal Business Name): NANNIES FOR GRANNIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2012
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 SUNSET LN
PATCHOGUE NY
11772-3418
US

IV. Provider business mailing address

34 SUNSET LN
PATCHOGUE NY
11772-3418
US

V. Phone/Fax

Practice location:
  • Phone: 631-730-8500
  • Fax: 631-730-8560
Mailing address:
  • Phone: 631-730-8500
  • Fax: 631-730-8560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1804-L
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. PAT THELIAN
Title or Position: DIRECTOR
Credential:
Phone: 631-730-8500