Healthcare Provider Details

I. General information

NPI: 1659761518
Provider Name (Legal Business Name): WHITE GLOVES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2015
Last Update Date: 01/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 SHEFFIELD AVE APT 4F
BROOKLYN NY
11207-4728
US

IV. Provider business mailing address

428 SHEFFIELD AVE APT 4F
BROOKLYN NY
11207-4728
US

V. Phone/Fax

Practice location:
  • Phone: 347-365-7705
  • Fax:
Mailing address:
  • Phone: 347-365-7705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number319913-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number319913-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number319913-1
License Number StateNY

VIII. Authorized Official

Name: MARITZA GUEVARA
Title or Position: LPN
Credential:
Phone: 347-365-7705