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General NPI Number Information
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NPI Number | 1083920755
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Entity Type | Organization
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Legal Business Name | MRS. G'S SERVICES, LLC
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Dates
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Enumeration Date | 08/19/2010
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Last Update Date | 08/19/2010
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Provider Practice Location Address
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Address Line | 134 PONINGO ST
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City | PORT CHESTER
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State | NY
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Zip | 10573-4010
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Country | US
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Telephone | 914-653-0123
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Fax | 914-819-0833
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Provider Business Mailing Address
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Address Line | 134 PONINGO ST
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City | PORT CHESTER
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State | NY
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Zip | 10573-4010
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Country | US
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Telephone | 914-653-0123
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Fax | 914-819-0833
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Authorized Official
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Title or Position | CEO
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Name | MR. SASHA BILLY GUILLAUME
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Credential |
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Telephone | 914-653-0123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 1524L001
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License Number State | NY
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