MEDICARE: PROLIFE HOME 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	2572L001	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
2	1861939738	OTHER	NY	NPI

General Provider Information

NPI Number	:	1356876114
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROLIFE HOME CARE, INC.

Provider Business Mailing Address
First Line	:	7701 BAY PKWY STE 1F
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-1541
Country	:	US
Telephone Number	:	718-232-2777
Fax Number	:	718-232-2778

Provider Business Practice Location Address
First Line	:	7701 BAY PKWY STE 1F
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-1541
Country	:	US
Telephone Number	:	718-232-2777
Fax Number	:	718-232-2778

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANASTASIIA RYBAKOVA
Credential	:
Telephone Number	:	718-232-2777

Provider Enumeration Date	:	04/28/2017
Last Update Date	:	04/28/2017

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Directions to “PROLIFE HOME CARE, INC. ” Practice Location

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