Healthcare Provider Details

I. General information

NPI: 1093465841
Provider Name (Legal Business Name): CHARLOTTE WEIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALTERNATE CHOICE HOME CARE

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 03/25/2022
Certification Date: 03/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12601 LIBERTY AVE
SOUTH RICHMOND HILL NY
11419-2219
US

IV. Provider business mailing address

12601 LIBERTY AVE
SOUTH RICHMOND HILL NY
11419-2219
US

V. Phone/Fax

Practice location:
  • Phone: 347-975-2525
  • Fax:
Mailing address:
  • Phone: 347-975-2525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number9076L001
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: