NPIMap

Organization Active NPI

Home Aide Service of Eastern New York, Inc.

Doing business as Eddy Visiting Nurse Association

  • Home Health Agency
  • Troy, NY
National Provider Identifier
1114967924
Registry record updated Mar 26, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
1921601 Issued in NY
Legal business name
HOME AIDE SERVICE OF EASTERN NEW YORK, INC.
Doing business as
Eddy Visiting Nurse Association
Practice address
433 River St
Suite 3000
Troy, NY 12180-2238
Phone
(518) 274-6200
Fax
(518) 274-1829
NPI assigned
Jun 8, 2006
Last updated
Mar 26, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2009

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

Authorized official

Name
Mrs. Michelle T Mazzacco
Title
VP/Director
Phone
(518) 270-1310

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 1921601 NY Primary
Home Health Agency 251E00000X 1921901L NY

Addresses

Primary practice location

433 River St
Suite 3000
Troy, NY 12180-2238

Mailing address

433 River St
Suite 3000
Troy, NY 12180-2238
Phone (518) 274-6200

Other identifiers 10

IdentifierTypeStateIssuer
000400078000OtherNYBSNENY, SR BLUE
10002765OtherNYCDPHP
7408289OtherNYAETNA
004116OtherNYEMPIRE BC
990069OtherNYMVP
00872739MedicaidNY
3503OtherNYGHI
040401000507OtherNYFIDELIS
00896511MedicaidNY
702486OtherNYHARVARD PILGRIM

Other names 1

  • Eddy Visiting Nurse Association Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050325000183 NY Part A Provider - Home Health Agency 7315993011 Practice locations: Catskill, NY; Troy, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1114967924. Details of each certification follow.

Home health agency certification: CCN 337203

Legal name
HOME AIDE SERVICE OF EASTERN NEW YORK, INC.
Doing business as
EDDY VISITING NURSE & REHAB ASSOCIATION
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jan 2, 1985
Last certification
Apr 27, 2012
Ownership / control type
Non-Profit
Organization structure
CorporationNon-profit
Incorporated
May 27, 1958 in NY
Enrollment address
433 River St
Ste 3000
Troy, NY 12180-2250

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Home health agency

Medicare Care Compare
Listed as
Eddy Visiting Nurse & Rehab AssociationCCN 337203 · All quality measures
Overall star rating
5 of 5
Ownership
Non-Profit
Certified
Jan 2, 1985
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory
Tax ID family
Home Aide SVC of Eastern Ny3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Locations

433 River St
Fl 3
Troy, NY 12180
Phone (518) 274-6200

433 River St
Ste 3000
Troy, NY 12180
Phone (518) 274-6200

Ownership & related parties

All disclosed owners & managing parties 18

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Merriette Pollard Individual Corporate DirectorBoard Member Oct 5, 2022 7.14%
Eric Farrell Individual Corporate DirectorBoard Secretary/Legal Counsel Jul 1, 2023
St Peters Health Partners Organization, Albany, NY Non-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Oct 1, 2011
John Marshall Individual Corporate DirectorTreasurer Oct 5, 2022 7.15%
Kathleen M Jimino Individual Corporate DirectorBoard Chair Jan 1, 2021 7.15%
William Wildridge Individual Corporate DirectorVice Chair Oct 5, 2022 7.14%
Steven Donald Hanks Individual Corporate DirectorEx-Officio Board Member Jan 1, 2023 7.14%
Michael Meath Individual Corporate DirectorBoard Member Oct 5, 2022 7.14%
Guha Bala Individual Corporate DirectorBoard Member Jan 1, 2021 7.14%
Gina Myers Individual Corporate DirectorBoard Member Oct 5, 2022 7.14%
Michelle T Mazzacco Individual Corporate OfficerVice President Feb 5, 2023
W-2 Managing EmployeeVice President Dec 26, 1999
Home Aide Service of Eastern New York, Inc. Organization, Troy, NY Operational/Managerial Control May 27, 1958 100%
Marguerite Sullivan Individual Corporate DirectorBoard Member Jan 1, 2025
Trinity Health Corporation Organization, Livonia, MI Non-profit 5% Or Greater Direct Ownership Interest Jul 1, 2014 100%
Daniel Isacksen Individual Corporate DirectorEx-Officio Board Member Oct 5, 2022 7.14%
Kerri Sweet Zavaglia Individual Corporate DirectorBoard Member Oct 5, 2022 7.14%
Robert J McCormick Individual Corporate DirectorBoard Member Jan 1, 2015 7.15%
Oluwatoyin Tofade Individual Corporate DirectorBoard Member Jan 1, 2024

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 157

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 157

Practitioners & affiliated clinicians

Affiliated clinicians 345

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 345

NPI Registry JSON

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

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1238025600000",
    "number": "1114967924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "433 RIVER ST",
            "address_2": "SUITE 3000",
            "city": "TROY",
            "state": "NY",
            "postal_code": "121802238",
            "telephone_number": "518-274-6200",
            "fax_number": "518-274-1829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "433 RIVER ST",
            "address_2": "SUITE 3000",
            "city": "TROY",
            "state": "NY",
            "postal_code": "121802238",
            "telephone_number": "518-274-6200",
            "fax_number": "518-274-1829"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOME AIDE SERVICE OF EASTERN NEW YORK, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-08",
        "last_updated": "2009-03-26",
        "status": "A",
        "authorized_official_last_name": "MAZZACCO",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "VP/DIRECTOR",
        "authorized_official_telephone_number": "518-270-1310",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NY",
            "license": "1921601",
            "primary": true
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NY",
            "license": "1921901L",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BSNENY, SR BLUE",
            "identifier": "000400078000",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CDPHP",
            "identifier": "10002765",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7408289",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMPIRE BC",
            "identifier": "004116",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP",
            "identifier": "990069",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00872739",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI",
            "identifier": "3503",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIDELIS",
            "identifier": "040401000507",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00896511",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARVARD PILGRIM",
            "identifier": "702486",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eddy Visiting Nurse Association",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Troy, NY

Sources for this page

Verify at the official NPI Registry.