MEDICARE: TRI-BOROUGH CERTIFIED HEALTH SYSTEMS OF NEW YORK. 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		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	:	1811324783
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI-BOROUGH CERTIFIED HEALTH SYSTEMS OF NEW YORK. LLC

Provider Business Mailing Address
First Line	:	1414 UTICA AVE
Second Line	:	2ND FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11203-6616
Country	:	US
Telephone Number	:	718-745-7508
Fax Number	:

Provider Business Practice Location Address
First Line	:	1414 UTICA AVE
Second Line	:	2ND FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11203-6616
Country	:	US
Telephone Number	:	718-745-7508
Fax Number	:

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	MR. KENRICK CORT
Credential	:
Telephone Number	:	718-282-7619

Provider Enumeration Date	:	10/08/2013
Last Update Date	:	05/05/2022

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