Healthcare Provider Details

I. General information

NPI: 1639298474
Provider Name (Legal Business Name): INDEPENDENT NURSING CARE L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1038 DAVIS ROAD
WEST FALLS NY
14170-0489
US

IV. Provider business mailing address

1038 DAVIS ROAD PO BOX 489
WEST FALLS NY
14170-9734
US

V. Phone/Fax

Practice location:
  • Phone: 716-655-8776
  • Fax: 716-655-7877
Mailing address:
  • Phone: 716-655-8776
  • Fax: 716-655-7877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1202L001
License Number StateNY

VIII. Authorized Official

Name: MRS. JULIE A GEMEREK
Title or Position: OWNER
Credential: RN
Phone: 716-655-8776