MEDICARE: ACCOLADE CARE 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	311ZA0620X	Adult Care Home Facility	2421L	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2016052313054695201	OTHER	NY	OMIG

General Provider Information

NPI Number	:	1942657523
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACCOLADE CARE INC

Provider Business Mailing Address
First Line	:	573 CARY AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10310-1902
Country	:	US
Telephone Number	:	718-675-9655
Fax Number	:	718-816-0373

Provider Business Practice Location Address
First Line	:	2015 FOREST AVE STE C3
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10303-1736
Country	:	US
Telephone Number	:	646-633-6375
Fax Number	:	718-390-0500

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. ADEWALE OSINUGA
Credential	:
Telephone Number	:	646-633-6375

Provider Enumeration Date	:	05/24/2016
Last Update Date	:	03/13/2024

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