MEDICARE: PREFERRED CERTIFIED, LLC

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

General Provider Information

NPI Number	:	1164021887
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREFERRED CERTIFIED, LLC

Provider Business Mailing Address
First Line	:	2003 CONEY ISLAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-2328
Country	:	US
Telephone Number	:	914-328-3733
Fax Number	:

Provider Business Practice Location Address
First Line	:	4 W PROSPECT AVE
Second Line	:
City	:	MOUNT VERNON
State	:	NY
Zip	:	10550-2027
Country	:	US
Telephone Number	:	914-328-3733
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JACLYN DIANA
Credential	:
Telephone Number	:	212-356-4200

Provider Enumeration Date	:	10/23/2020
Last Update Date	:	10/04/2024

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