Provider Demographics
NPI:1124051412
Name:INTERIM HEALTHCARE OF SYRACUSE, INC
Entity type:Organization
Organization Name:INTERIM HEALTHCARE OF SYRACUSE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:C
Authorized Official - Last Name:BYRNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-437-4500
Mailing Address - Street 1:3502 JAMES STREET
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13206
Mailing Address - Country:US
Mailing Address - Phone:315-437-4500
Mailing Address - Fax:315-437-1632
Practice Address - Street 1:3502 JAMES STREET
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13206
Practice Address - Country:US
Practice Address - Phone:315-437-4500
Practice Address - Fax:315-437-1632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9669L001251E00000X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00588005Medicaid
NY00681989Medicaid
NY56437BMedicare ID - Type Unspecified