Provider Demographics
NPI:1174725386
Name:AFFILIATED HOME CARE OF PUTNAM, INC.
Entity type:Organization
Organization Name:AFFILIATED HOME CARE OF PUTNAM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:KESSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-628-2484
Mailing Address - Street 1:PO BOX 213
Mailing Address - Street 2:4 MARINA DRIVE #K-1
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541-0213
Mailing Address - Country:US
Mailing Address - Phone:845-628-2484
Mailing Address - Fax:845-628-2507
Practice Address - Street 1:4 MARINA DR APT K1
Practice Address - Street 2:
Practice Address - City:MAHOPAC
Practice Address - State:NY
Practice Address - Zip Code:10541-1614
Practice Address - Country:US
Practice Address - Phone:845-628-2484
Practice Address - Fax:845-628-2507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9236L001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00910623Medicaid