=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831572643
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GREATCARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2015
-----------------------------------------------------
Last Update Date | 06/30/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 W 34TH ST RM 1207
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10001-2126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-267-5677
-----------------------------------------------------
Fax | 212-419-1284
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 407 PARK AVE S APT 6F
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10016-8416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-226-5679
-----------------------------------------------------
Fax | 212-419-1284
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MR. JIAN PENG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 646-226-5679
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 1475L-001
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------