Organization
EDIRA FAMILY HOME CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. IRINA KORNEYEVA (ADMINISTRATOR)
(917) 293-5250
Entity
Organization
Contact information
Practice address
EDIRA FAMILY HOME CARE LLC, 63-52 108 STREET LOWER LEVEL, FOREST HILLS, NY 11375
(917) 293-5250
(718) 830-6211
Mailing address
EDIRA FAMILY HOME CARE LLC, 63-52 108 STREET LOWER LEVEL, FOREST HILLS, NY 11375
(917) 293-5250
(718) 830-6211
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
2546L001
NY
374U00000X
Home Health Aide
Primary
2546L001
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2546L001
HOME CARE SERVICE AGENCY LICENSE
NY
Enumeration date
04/12/2018
Last updated
04/12/2018
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