=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003156225
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ISABELLA CARE AT HOME INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/25/2013
-----------------------------------------------------
Last Update Date | 05/01/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 515 AUDUBON AVE
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10040-3403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-342-9309
-----------------------------------------------------
Fax | 212-342-9666
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5073 BROADWAY
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10034-1131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-342-9309
-----------------------------------------------------
Fax | 212-342-9666
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT-CEO
-----------------------------------------------------
Name | MR. MARK J. KATOR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 212-342-9300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------