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Organization
ACTIVITIES OF DAILY LIVING HOME CARE
Active
Organization
ACTIVITIES OF DAILY LIVING HOME CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENDRA DENISE LEWIS (CNA)
(631) 394-6639
Entity
Organization
Contact information
Practice address
67 DIANA DR, MASTIC BEACH, NY 11951-6308
(631) 394-6639
Mailing address
67 DIANA DR, MASTIC BEACH, NY 11951-6308
(631) 394-6639
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
NY
320700000X
Physical Disabilities Residential Treatment Facility
—
NY
320800000X
Mental Illness Community Based Residential Treatment Facility
—
NY
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
NY
323P00000X
Psychiatric Residential Treatment Facility
—
NY
347C00000X
Private Vehicle
—
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
32-038829
MEDICAID MEDICARE
NY
Enumeration date
09/11/2012
Last updated
07/21/2022
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