MEDICARE: PORT MORRIS HOME CARE AGENCY, 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	0619L001	NY

General Provider Information

NPI Number	:	1265796098
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PORT MORRIS HOME CARE AGENCY, LLC

Provider Business Mailing Address
First Line	:	3093 OCEAN AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3405
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3530 WAYNE AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-1511
Country	:	US
Telephone Number	:	718-655-1700
Fax Number	:	718-798-7691

Authorized Official
Title or Position	:	DIRECTOR OF FINANCE
Name	:	MR. BENJAMIN S FELDMAN
Credential	:
Telephone Number	:	718-655-1700

Provider Enumeration Date	:	06/26/2012
Last Update Date	:	12/26/2023

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