Provider Demographics
NPI:1972870475
Name:LA BELLA HOMECARE
Entity type:Organization
Organization Name:LA BELLA HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN NURSING
Authorized Official - Prefix:MS
Authorized Official - First Name:KERBY
Authorized Official - Middle Name:
Authorized Official - Last Name:LUC
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:646-660-2623
Mailing Address - Street 1:225-19 114TH ROAD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11411-1309
Mailing Address - Country:US
Mailing Address - Phone:646-660-2623
Mailing Address - Fax:
Practice Address - Street 1:22519 114TH RD
Practice Address - Street 2:
Practice Address - City:CAMBRIA HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11411-1309
Practice Address - Country:US
Practice Address - Phone:646-660-2623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY283560302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization