- Enrollment id
- O20060406000284
- Enrollment state
- NY
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1841233178
- Multiple npi flag
- N
- Ccn
- 337299
- Associate id
- 3072522812
- Organization name
- GAMZEL NY, INC
- Doing business as name
- REVIVAL HOME HEALTH CARE
- Incorporation date
- 2006-01-01
- Incorporation state
- NY
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 75 VANDERBILT AVE
- Address line 2
- FL 3
- City
- STATEN ISLAND
- State
- NY
- Zip code
- 103042604
- Practice location type
- HHA BRANCH