Provider Demographics
NPI:1386797611
Name:FULL CARE, INC.
Entity type:Organization
Organization Name:FULL CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:J
Authorized Official - Last Name:GERARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-536-1490
Mailing Address - Street 1:189 SUNRISE HWY
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-4713
Mailing Address - Country:US
Mailing Address - Phone:516-536-1490
Mailing Address - Fax:516-536-2502
Practice Address - Street 1:719 W NYACK RD
Practice Address - Street 2:SUITE 27
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-2240
Practice Address - Country:US
Practice Address - Phone:845-358-2002
Practice Address - Fax:845-358-8904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9422L001251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01416173Medicaid
NY01769144Medicaid