MEDICARE: EAST GREENBUSH HOME HEALTH AIDE

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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1497426241
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST GREENBUSH HOME HEALTH AIDE

Provider Business Mailing Address
First Line	:	265 HUDSON AVE E
Second Line	:
City	:	RENSSELAER
State	:	NY
Zip	:	12144-3743
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	265 HUDSON AVE E
Second Line	:
City	:	RENSSELAER
State	:	NY
Zip	:	12144-3743
Country	:	US
Telephone Number	:	518-496-3437
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	HINA LIAQAT
Credential	:
Telephone Number	:	518-496-3437

Provider Enumeration Date	:	09/22/2021
Last Update Date	:	09/22/2021

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