Healthcare Provider Details

I. General information

NPI: 1104055888
Provider Name (Legal Business Name): HOME SWEET HOMECARE OF LI INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2009
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4747 NESCONSET HWY UNIT 28
PORT JEFFERSON STA NY
11776
US

IV. Provider business mailing address

4747 NESCONSET HWY UNIT 28
PORT JEFFERSON ST NY
11776
US

V. Phone/Fax

Practice location:
  • Phone: 631-828-8874
  • Fax: 631-473-0870
Mailing address:
  • Phone: 631-828-8874
  • Fax: 631-473-0870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1551L-001
License Number StateNY

VIII. Authorized Official

Name: MRS. CATHERINE JONES
Title or Position: OWNER
Credential:
Phone: 631-828-8874