MEDICARE: CELESTIAL CARE INC.

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		NY

General Provider Information

NPI Number	:	1275076804
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CELESTIAL CARE INC.

Provider Business Mailing Address
First Line	:	10712 125TH ST
Second Line	:
City	:	SOUTH RICHMOND HILL
State	:	NY
Zip	:	11419-2914
Country	:	US
Telephone Number	:	347-969-1626
Fax Number	:

Provider Business Practice Location Address
First Line	:	10712 125TH ST
Second Line	:
City	:	SOUTH RICHMOND HILL
State	:	NY
Zip	:	11419-2914
Country	:	US
Telephone Number	:	347-969-1626
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ARVIN SHIVPAUL
Credential	:
Telephone Number	:	347-969-1626

Provider Enumeration Date	:	11/30/2016
Last Update Date	:	11/30/2016

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