Professional Care Home Care Agency, Inc.

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

HP0275000 Issued in NJ

Legal business name

PROFESSIONAL CARE HOME CARE AGENCY, INC.

Practice address

2050 Center Ave Ste 318
Fort Lee, NJ 07024-4932

Phone

(347) 683-5773

Fax

(201) 944-4029

NPI assigned

May 23, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Nellie Krivosheyev

Title

President

Phone

(347) 683-5773

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1527033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1527033600000",
    "number": "1083105175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2050 CENTER AVE STE 318",
            "city": "FORT LEE",
            "state": "NJ",
            "postal_code": "070244932",
            "telephone_number": "347-683-5773",
            "fax_number": "201-944-4029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2050 CENTER AVE STE 318",
            "city": "FORT LEE",
            "state": "NJ",
            "postal_code": "070244932",
            "telephone_number": "347-683-5773",
            "fax_number": "201-944-4029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL CARE HOME CARE AGENCY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-23",
        "last_updated": "2018-05-23",
        "status": "A",
        "authorized_official_last_name": "KRIVOSHEYEV",
        "authorized_official_first_name": "NELLIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "347-683-5773",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NJ",
            "license": "HP0275000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Home Health Agency in Fort Lee, NJ
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.