Healthcare Provider Details

I. General information

NPI: 1033473848
Provider Name (Legal Business Name): PC AIDE PLUS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2012
Last Update Date: 06/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13893 FRANCIS LEWIS BLVD
ROSEDALE NY
11422-1704
US

IV. Provider business mailing address

13893 FRANCIS LEWIS BLVD
ROSEDALE NY
11422-1704
US

V. Phone/Fax

Practice location:
  • Phone: 718-949-9004
  • Fax: 718-949-9005
Mailing address:
  • Phone: 718-949-9004
  • Fax: 718-949-9005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1495L001
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. SOUNDARAM SOM
Title or Position: PRESIDENT/OWNER
Credential: R.N.
Phone: 718-314-6004