Provider Demographics
NPI:1629679188
Name:LONG ISLAND SENIOR CARE LLC
Entity type:Organization
Organization Name:LONG ISLAND SENIOR CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WOODY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-233-5903
Mailing Address - Street 1:PO BOX 478
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07051-0478
Mailing Address - Country:US
Mailing Address - Phone:973-233-5903
Mailing Address - Fax:
Practice Address - Street 1:98 PARK ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07050-3723
Practice Address - Country:US
Practice Address - Phone:973-233-5903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-02
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty