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NPI Code Detail

MEDICARE: JACKSON HEIGHTS CARE CENTER, LLC

MEDICARE: JACKSON HEIGHTS CARE CENTER, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility7003397NNY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1144424805
Entity Type Code : Organization
Provider Name (Legal Business Name) : JACKSON HEIGHTS CARE CENTER, LLC
Provider Business Mailing Address
First Line : 7005 35TH AVE
Second Line :
City : JACKSON HEIGHTS
State : NY
Zip : 11372-3970
Country : US
Telephone Number : 718-662-5100
Fax Number : 718-565-9700
Provider Business Practice Location Address
First Line : 7005 35TH AVE
Second Line :
City : JACKSON HEIGHTS
State : NY
Zip : 11372-3970
Country : US
Telephone Number : 718-662-5100
Fax Number : 718-565-9700
Authorized Official
Title or Position : ADMINISTRATOR
Name : MR. KWANG C LEE
Credential :
Telephone Number : 718-662-5100
Provider Enumeration Date : 06/14/2007
Last Update Date : 09/13/2010

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Directions to “JACKSON HEIGHTS CARE CENTER, LLC ” Practice Location

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