=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710308309
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOME ALONE CARE & ACCESSORIES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/27/2013
-----------------------------------------------------
Last Update Date | 12/27/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8125 254TH ST
-----------------------------------------------------
City | FLORAL PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11004-1437
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-250-4875
-----------------------------------------------------
Fax | 718-831-8612
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8125 254TH ST
-----------------------------------------------------
City | FLORAL PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11004-1437
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-250-4875
-----------------------------------------------------
Fax | 718-831-8612
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. SELWYN H MARAKACHERRY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 516-250-4875
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 347C00000X
-----------------------------------------------------
Taxonomy Name | Private Vehicle
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 332BC3200X
-----------------------------------------------------
Taxonomy Name | Customized Equipment (DME)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------