Basic Information
| Provider Information | |||||||||
| NPI: | 1720200546 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ACCUCARE NURSING & HOMECARE | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 20 OLD TURNPIKE RD | ||||||||
| Address2: | SUITE 307 | ||||||||
| City: | NANUET | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109542532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8456240260 | ||||||||
| FaxNumber: | 8456240264 | ||||||||
| Practice Location | |||||||||
| Address1: | 20 OLD TURNPIKE RD | ||||||||
| Address2: | SUITE 307 | ||||||||
| City: | NANUET | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109542532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8456240260 | ||||||||
| FaxNumber: | 8456240264 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2007 | ||||||||
| LastUpdateDate: | 08/07/2007 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | FOOTE | ||||||||
| AuthorizedOfficialFirstName: | ELLEN | ||||||||
| AuthorizedOfficialMiddleName: | JANE | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 8456240260 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | RN | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251J00000X | 8079L001 | NY | Y | Agencies | Nursing Care |
ID Information
| ID | Type | State | Issuer | Description | 01138536 | 05 | NY | MEDICAID |