Provider Demographics
NPI:1528435872
Name:HOME
Entity type:Organization
Organization Name:HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:KESHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-295-4833
Mailing Address - Street 1:333 E 181ST ST
Mailing Address - Street 2:6N
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-2305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:333 E 181ST ST
Practice Address - Street 2:6N
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-2305
Practice Address - Country:US
Practice Address - Phone:718-295-4833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-21
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No282N00000XHospitalsGeneral Acute Care Hospital
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility