Healthcare Provider Details

I. General information

NPI: 1417497785
Provider Name (Legal Business Name): PEREGRINE HOMECARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2017
Last Update Date: 03/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 EAST GENESEE STREET SUITE 100
SKANEATELES NY
13152-8879
US

IV. Provider business mailing address

1551 EAST GENESEE STREET SUITE 100
SKANEATELES NY
13152
US

V. Phone/Fax

Practice location:
  • Phone: 315-685-5170
  • Fax: 315-685-5186
Mailing address:
  • Phone: 315-685-5170
  • Fax: 315-685-5186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1509L001
License Number StateNY

VIII. Authorized Official

Name: CASSANDRA ANN KALET-CLARE
Title or Position: EXECUTIVE DIRECTOR
Credential: R.N.
Phone: 315-685-5170