Provider Demographics
NPI:1104905363
Name:GREEN ACRES HOME CARE
Entity type:Organization
Organization Name:GREEN ACRES HOME CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CHALOFF
Authorized Official - Suffix:
Authorized Official - Credentials:ORTHOTIST
Authorized Official - Phone:516-825-0098
Mailing Address - Street 1:PO BOX 1594
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11582-1594
Mailing Address - Country:US
Mailing Address - Phone:516-825-0099
Mailing Address - Fax:516-374-2790
Practice Address - Street 1:360 SHORE RD
Practice Address - Street 2:10H
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-4300
Practice Address - Country:US
Practice Address - Phone:516-825-0099
Practice Address - Fax:516-374-2790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0387220001Medicare ID - Type Unspecified