Provider Demographics
NPI:1144863655
Name:LONG LIFE HOME CARE, INC
Entity type:Organization
Organization Name:LONG LIFE HOME CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAPON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:646-361-8798
Mailing Address - Street 1:61 MACE ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-1454
Mailing Address - Country:US
Mailing Address - Phone:646-361-8798
Mailing Address - Fax:646-349-2117
Practice Address - Street 1:61 MACE ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-1454
Practice Address - Country:US
Practice Address - Phone:646-361-8798
Practice Address - Fax:646-349-2117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health