Healthcare Provider Details

I. General information

NPI: 1124051412
Provider Name (Legal Business Name): INTERIM HEALTHCARE OF SYRACUSE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 09/11/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3502 JAMES STREET
SYRACUSE NY
13206
US

IV. Provider business mailing address

3502 JAMES STREET
SYRACUSE NY
13206
US

V. Phone/Fax

Practice location:
  • Phone: 315-437-4500
  • Fax: 315-437-1632
Mailing address:
  • Phone: 315-437-4500
  • Fax: 315-437-1632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number9669L001
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: JASON C BYRNES
Title or Position: PRESIDENT
Credential:
Phone: 315-437-4500