MEDICARE: C.A.R.E. MAVENS HOME HEALTH AGENCY 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	:	1528451200
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	C.A.R.E. MAVENS HOME HEALTH AGENCY LLC

Provider Business Mailing Address
First Line	:	2220 W 11TH ST
Second Line	:	APT 7D
City	:	BROOKLYN
State	:	NY
Zip	:	11223-4343
Country	:	US
Telephone Number	:	718-986-1417
Fax Number	:

Provider Business Practice Location Address
First Line	:	2220 W 11TH ST
Second Line	:	APT 7D
City	:	BROOKLYN
State	:	NY
Zip	:	11223-4343
Country	:	US
Telephone Number	:	718-986-1417
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JACKLYN SUKIE
Credential	:
Telephone Number	:	718-986-1417

Provider Enumeration Date	:	03/05/2015
Last Update Date	:	03/05/2015

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