Healthcare Provider Details

I. General information

NPI: 1568359628
Provider Name (Legal Business Name): ASHSHAV DIGNITY CARE HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2025
Last Update Date: 06/21/2025
Certification Date: 06/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13445 155TH ST
JAMAICA NY
11434-3619
US

IV. Provider business mailing address

13445 155TH ST
JAMAICA NY
11434-3619
US

V. Phone/Fax

Practice location:
  • Phone: 929-248-7229
  • Fax:
Mailing address:
  • Phone: 929-248-7229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: TRACEY-ANN NEMBHARD
Title or Position: FOUNDER & ADMINISTRATOR
Credential:
Phone: 929-248-7229