MEDICARE: JS HOMECARE AGENCY OF NY, 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	1906L001	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	:	1467999268
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JS HOMECARE AGENCY OF NY, INC.

Provider Business Mailing Address
First Line	:	4318 8TH AVE FL 1
Second Line	:	JS HOMECARE AGENCY OF NY
City	:	BROOKLYN
State	:	NY
Zip	:	11232-3910
Country	:	US
Telephone Number	:	347-834-7216
Fax Number	:

Provider Business Practice Location Address
First Line	:	4318 8TH AVE FL 1
Second Line	:	JS HOMECARE AGENCY OF NY
City	:	BROOKLYN
State	:	NY
Zip	:	11232-3910
Country	:	US
Telephone Number	:	347-834-7216
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	LAN CHEN
Credential	:
Telephone Number	:	347-834-7216

Provider Enumeration Date	:	01/31/2017
Last Update Date	:	01/31/2017

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