Provider Demographics
NPI:1801336318
Name:EFFECTIVE HOME CARE LLC
Entity type:Organization
Organization Name:EFFECTIVE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:KANOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-806-1666
Mailing Address - Street 1:35-01 30TH AVENUE
Mailing Address - Street 2:SUITE # 405
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-4669
Mailing Address - Country:US
Mailing Address - Phone:718-806-1666
Mailing Address - Fax:718-806-1506
Practice Address - Street 1:35-01 30TH AVENUE
Practice Address - Street 2:SUITE # 405
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-4669
Practice Address - Country:US
Practice Address - Phone:718-806-1666
Practice Address - Fax:718-806-1506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-02
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2001L001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04201323Medicaid