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General NPI Number Information
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NPI Number | 1750827762
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Entity Type | Organization
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Legal Business Name | MAVENCARE (NY) INC.
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Dates
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Enumeration Date | 01/13/2017
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Last Update Date | 01/13/2017
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Provider Practice Location Address
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Address Line | 79 MADISON AVE # 438
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City | NEW YORK
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State | NY
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Zip | 10016-7802
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Country | US
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Telephone | 646-887-2333
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Fax |
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Provider Business Mailing Address
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Address Line | 79 MADISON AVE # 438
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City | NEW YORK
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State | NY
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Zip | 10016-7802
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Country | US
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Telephone | 646-887-2333
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Fax |
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Authorized Official
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Title or Position | SVP, US OPERATIONS
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Name | MS. MICHELLE ZIMMERMAN
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Credential | JD, MBA
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Telephone | 646-853-1126
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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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