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General NPI Number Information
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NPI Number | 1356679252
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Entity Type | Organization
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Legal Business Name | IDEAL HOME CARE SERVICES, INC.
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Dates
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Enumeration Date | 12/03/2009
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Last Update Date | 08/27/2014
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Provider Practice Location Address
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Address Line | 3241 ROUT2 112 BUILDING 7 SUITE 5
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City | MEDFORD
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State | NY
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Zip | 11763-1424
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Country | US
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Telephone | 631-509-5600
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Fax | 631-509-5599
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Provider Business Mailing Address
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Address Line | 3241 ROUT2 112 BUILDING 7 SUITE 5
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City | MEDFORD
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State | NY
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Zip | 11763-1424
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Country | US
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Telephone | 631-509-5600
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Fax | 631-509-5599
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Authorized Official
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Title or Position | NURSE COORDINATOR
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Name | MRS. MARIE NICOLE LABORDE
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Credential | RN
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Telephone | 631-509-5600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 1971L001
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License Number State | NY
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