Provider Demographics
NPI:1265711238
Name:PRIDECARE, INC.
Entity type:Organization
Organization Name:PRIDECARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:A
Authorized Official - Last Name:MIRRA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:484-494-3121
Mailing Address - Street 1:420 LEXINGTON AVE RM 910
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10170-0047
Mailing Address - Country:US
Mailing Address - Phone:646-882-0103
Mailing Address - Fax:
Practice Address - Street 1:420 LEXINGTON AVE RM 910
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10170-0047
Practice Address - Country:US
Practice Address - Phone:646-882-0103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-09
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0634L001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health