MEDICARE: CHAI HOMECARE 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	:	1366078446
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHAI HOMECARE LLC

Provider Business Mailing Address
First Line	:	1613 MCDONALD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-6310
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1613 MCDONALD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-6310
Country	:	US
Telephone Number	:	718-670-6300
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	AJ WEISS
Credential	:
Telephone Number	:	718-670-6300

Provider Enumeration Date	:	03/20/2020
Last Update Date	:	03/20/2020

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