=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205007507
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AFFABLE HOME CARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2008
-----------------------------------------------------
Last Update Date | 09/13/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1674 BROADWAY STE 502
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10019-5858
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-850-9444
-----------------------------------------------------
Fax | 212-608-2901
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1674 BROADWAY STE 502
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10019-5858
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-850-9444
-----------------------------------------------------
Fax | 212-608-2901
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MR. GABRIEL J. MAROUS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 718-850-9444
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 9899L001
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------