MEDICARE: CROWN OF LIFE NY 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	2662L001	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

General Provider Information

NPI Number	:	1396280715
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROWN OF LIFE NY LLC

Provider Business Mailing Address
First Line	:	1368 60TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-5018
Country	:	US
Telephone Number	:	718-475-2333
Fax Number	:	718-475-2323

Provider Business Practice Location Address
First Line	:	1368 60TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-5018
Country	:	US
Telephone Number	:	718-475-2333
Fax Number	:	718-475-2323

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JACQUELINE MORALES
Credential	:
Telephone Number	:	718-475-2323

Provider Enumeration Date	:	12/20/2016
Last Update Date	:	09/26/2025

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Directions to “CROWN OF LIFE NY LLC ” Practice Location

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