NPIMap

Organization Active NPI

Activities of Daily Living Home Care

  • Home Health Agency
  • Mastic Beach, NY
National Provider Identifier
1376893941
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
ACTIVITIES OF DAILY LIVING HOME CARE
Practice address
67 Diana Dr
Mastic Beach, NY 11951-6308
Phone
(631) 394-6639
NPI assigned
Sep 11, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Kendra Denise Lewis
Title
Cna
Phone
(631) 394-6639

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X NY Primary
Physical Disabilities Residential Treatment Facility 320700000X NY
Mental Illness Community Based Residential Treatment Facility 320800000X NY
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X NY
Psychiatric Residential Treatment Facility 323P00000X NY
Private Vehicle 347C00000X NY

Addresses

Primary practice location

67 Diana Dr
Mastic Beach, NY 11951-6308

Mailing address

67 Diana Dr
Mastic Beach, NY 11951-6308
Phone (631) 394-6639

Other identifiers 1

IdentifierTypeStateIssuer
32-038829OtherNYMEDICAID MEDICARE

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1347321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1376893941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "67 DIANA DR",
            "city": "MASTIC BEACH",
            "state": "NY",
            "postal_code": "119516308",
            "telephone_number": "631-394-6639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "67 DIANA DR",
            "city": "MASTIC BEACH",
            "state": "NY",
            "postal_code": "119516308",
            "telephone_number": "631-394-6639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVITIES OF DAILY LIVING HOME CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-11",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "LEWIS",
        "authorized_official_first_name": "KENDRA",
        "authorized_official_middle_name": "DENISE",
        "authorized_official_title_or_position": "CNA",
        "authorized_official_telephone_number": "631-394-6639"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NY",
            "license": null,
            "primary": true
        },
        {
            "code": "320700000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Physical Disabilities",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "347C00000X",
            "taxonomy_group": "",
            "desc": "Private Vehicle",
            "state": "NY",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID MEDICARE",
            "identifier": "32-038829",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mastic Beach, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.