Healthcare Provider Details

I. General information

NPI: 1275987760
Provider Name (Legal Business Name): WHITE GLOVE HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2016
Last Update Date: 04/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 FLUSHING AVE
BROOKLYN NY
11206-5026
US

IV. Provider business mailing address

14995 254TH ST
ROSEDALE NY
11422-2724
US

V. Phone/Fax

Practice location:
  • Phone: 718-828-2666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number7141621
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number7141621
License Number StateNY

VIII. Authorized Official

Name: JOHANNIE CHANCY MONDESIR
Title or Position: REGISTERED NURSE
Credential:
Phone: 561-634-6519