Provider Demographics
NPI:1104451152
Name:TAYLOR MADE HOME CARE AGENCY
Entity type:Organization
Organization Name:TAYLOR MADE HOME CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-744-6161
Mailing Address - Street 1:1389 HEMPSTEAD TPKE
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-2546
Mailing Address - Country:US
Mailing Address - Phone:516-744-6161
Mailing Address - Fax:516-775-6160
Practice Address - Street 1:1389 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-2546
Practice Address - Country:US
Practice Address - Phone:516-744-6161
Practice Address - Fax:516-775-6160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty