MEDICARE: ST. NICHOLAS HUMAN SUPPORT CORPORATION

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	251E00000X	Home Health Agency	0899L001	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124156740
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. NICHOLAS HUMAN SUPPORT CORPORATION

Provider Business Mailing Address
First Line	:	11 CATHERINE ST
Second Line	:	3RD FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11211-2706
Country	:	US
Telephone Number	:	718-388-5522
Fax Number	:	718-388-0476

Provider Business Practice Location Address
First Line	:	11 CATHERINE ST
Second Line	:	3RD FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11211-2706
Country	:	US
Telephone Number	:	718-388-5522
Fax Number	:	718-388-0476

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. MICHAEL ROCHFORD
Credential	:
Telephone Number	:	718-388-5522

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	08/22/2020

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