=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922073360
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ST ELIZABETH'S HOMECARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14 FOERY DR
-----------------------------------------------------
City | UTICA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13501-6236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-797-9770
-----------------------------------------------------
Fax | 315-732-7216
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14 FOERY DR
-----------------------------------------------------
City | UTICA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13501-6236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-797-9770
-----------------------------------------------------
Fax | 315-732-7216
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MARCIA MARTIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 315-797-9770
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 0975L001
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------