Provider Demographics
NPI:1033319074
Name:BALM OF GILEAD HOMECARE AGENCY
Entity type:Organization
Organization Name:BALM OF GILEAD HOMECARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:EMILI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-944-1776
Mailing Address - Street 1:3515 EASTCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-1670
Mailing Address - Country:US
Mailing Address - Phone:718-944-1776
Mailing Address - Fax:
Practice Address - Street 1:3515 EASTCHESTER RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-1670
Practice Address - Country:US
Practice Address - Phone:718-944-1776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0992L001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02204135Medicaid