Healthcare Provider Details

I. General information

NPI: 1700322872
Provider Name (Legal Business Name): INTERIM HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2017
Last Update Date: 01/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 RED MILLS RD
WALLKILL NY
12589-3281
US

IV. Provider business mailing address

800 RED MILLS RD
WALLKILL NY
12589-3281
US

V. Phone/Fax

Practice location:
  • Phone: 845-269-9176
  • Fax:
Mailing address:
  • Phone: 845-269-9176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number8985322
License Number StateNY

VIII. Authorized Official

Name: KIA ELIZABETH COBB
Title or Position: UAS ASSESSOR
Credential: RN
Phone: 845-269-9176