Provider Demographics
NPI:1528451200
Name:C.A.R.E. MAVENS HOME HEALTH AGENCY LLC
Entity type:Organization
Organization Name:C.A.R.E. MAVENS HOME HEALTH AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACKLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SUKIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-986-1417
Mailing Address - Street 1:2220 W 11TH ST
Mailing Address - Street 2:APT 7D
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-4343
Mailing Address - Country:US
Mailing Address - Phone:718-986-1417
Mailing Address - Fax:
Practice Address - Street 1:2220 W 11TH ST
Practice Address - Street 2:APT 7D
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-4343
Practice Address - Country:US
Practice Address - Phone:718-986-1417
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health