Provider Demographics
NPI:1285749457
Name:MOHAWK VALLEY HOME CARE LLC
Entity type:Organization
Organization Name:MOHAWK VALLEY HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PATIENT SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LAZAREK-LAQUAY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:315-624-8900
Mailing Address - Street 1:2521 SUNSET AVENUE
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-5825
Mailing Address - Country:US
Mailing Address - Phone:315-624-4660
Mailing Address - Fax:315-624-4665
Practice Address - Street 1:2521 SUNSET AVENUE
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-5825
Practice Address - Country:US
Practice Address - Phone:315-624-4663
Practice Address - Fax:315-624-4540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01496088Medicaid
NY01496088Medicaid