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General NPI Number Information
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NPI Number | 1104397322
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Entity Type | Organization
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Legal Business Name | CIVILITY HOME CARE, LLC
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Dates
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Enumeration Date | 12/16/2018
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Last Update Date | 08/09/2022
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Provider Practice Location Address
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Address Line | 155 MAIN STREET, STE 104
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City | BREWSTER
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State | NY
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Zip | 10509
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Country | US
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Telephone | 845-278-1727
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Fax | 845-278-1930
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Provider Business Mailing Address
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Address Line | 155 MAIN STREET, STE 104
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City | BREWSTER
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State | NY
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Zip | 10509
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Country | US
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Telephone | 845-278-1727
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Fax | 845-278-1930
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DARYN CLARK
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Credential |
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Telephone | 203-942-3677
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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 |
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License Number State |
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