MEDICARE: INTERIM HEALTHCARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251J00000X	Nursing Care Agency	292427	NY

General Provider Information

NPI Number	:	1033653696
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERIM HEALTHCARE

Provider Business Mailing Address
First Line	:	112 UNION RD
Second Line	:	APT 2S
City	:	SPRING VALLEY
State	:	NY
Zip	:	10977-3448
Country	:	US
Telephone Number	:	845-664-8668
Fax Number	:

Provider Business Practice Location Address
First Line	:	112 UNION RD
Second Line	:	APT 2S
City	:	SPRING VALLEY
State	:	NY
Zip	:	10977-3448
Country	:	US
Telephone Number	:	845-664-8668
Fax Number	:

Authorized Official
Title or Position	:	LPN
Name	:	GREGORY CALVAIRE
Credential	:
Telephone Number	:	845-664-8668

Provider Enumeration Date	:	12/15/2016
Last Update Date	:	12/15/2016

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