Healthcare Provider Details

I. General information

NPI: 1558973156
Provider Name (Legal Business Name): MULTICOMMUNITY SERVICES AT 95
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 RUTLAND RD
BROOKLYN NY
11212-2374
US

IV. Provider business mailing address

1034 RUTLAND RD
BROOKLYN NY
11212-2374
US

V. Phone/Fax

Practice location:
  • Phone: 718-676-0133
  • Fax: 718-221-6781
Mailing address:
  • Phone: 718-676-0133
  • Fax: 718-221-6781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2278H0200X
TaxonomyHome Health Certified Respiratory Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. BEVERLY JOY CREARY
Title or Position: OWNER
Credential:
Phone: 718-676-0133