Provider Demographics
NPI:1942843750
Name:RICHMOND HOME CARE AGENCY FI
Entity type:Organization
Organization Name:RICHMOND HOME CARE AGENCY FI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:EJIKEME
Authorized Official - Last Name:OKEKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-273-5211
Mailing Address - Street 1:PO BOX 41228
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-7228
Mailing Address - Country:US
Mailing Address - Phone:718-273-5211
Mailing Address - Fax:718-273-5222
Practice Address - Street 1:1375 BAY ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3901
Practice Address - Country:US
Practice Address - Phone:718-273-5211
Practice Address - Fax:718-273-5222
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RICHMOND HOME CARE AGENCY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-24
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04505648Medicaid