Provider Demographics
NPI:1538371778
Name:WHITE GLOVE COMMUNITY CARE, INC.
Entity type:Organization
Organization Name:WHITE GLOVE COMMUNITY CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER, CONTRACTS
Authorized Official - Prefix:
Authorized Official - First Name:BLIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-828-2666
Mailing Address - Street 1:89 BARTLETT ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-4463
Mailing Address - Country:US
Mailing Address - Phone:718-828-2666
Mailing Address - Fax:718-782-1538
Practice Address - Street 1:1470 ROUTE 88
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-2368
Practice Address - Country:US
Practice Address - Phone:844-828-2666
Practice Address - Fax:718-782-1538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251E00000X, 252Y00000X
NY9839L001253Z00000X, 251E00000X
NJHP0264700253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase Management
No252Y00000XAgenciesEarly Intervention Provider Agency
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04244515Medicaid
NY01718294Medicaid
NY03480779Medicaid