Healthcare Provider Details

I. General information

NPI: 1306934732
Provider Name (Legal Business Name): HOME FOR THE AGED OF THE LITTLE SISTERS OF THE POOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 10/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110-30 221ST STREET
QUEENS VILLAGE NY
11429-2513
US

IV. Provider business mailing address

110-30 221ST STREET
QUEENS VILLAGE NY
11429-2513
US

V. Phone/Fax

Practice location:
  • Phone: 718-464-1800
  • Fax:
Mailing address:
  • Phone: 718-464-1800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number7003303N
License Number StateNY

VIII. Authorized Official

Name: CELINE VADUKKOOT
Title or Position: CEO AND ADMINISTRATOR
Credential:
Phone: 718-464-1800