=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851666333
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KEARNEY HOME CARE SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/15/2012
-----------------------------------------------------
Last Update Date | 03/15/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 43-32 45 STREET
-----------------------------------------------------
City | LONG ISLAND CITY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11104-2302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-472-2273
-----------------------------------------------------
Fax | 718-472-5224
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 43-32 45 STREET
-----------------------------------------------------
City | LONG ISLAND CITY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11104-2302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-472-2273
-----------------------------------------------------
Fax | 718-472-5224
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MR. ANDREW SEARS
-----------------------------------------------------
Credential | N/A
-----------------------------------------------------
Telephone | 718-472-2273
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 9233L001
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------