Healthcare Provider Details

I. General information

NPI: 1801970629
Provider Name (Legal Business Name): RAPHA NURSING AGENCY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19930 HOLLIS AVE
SAINT ALBANS NY
11412-1232
US

IV. Provider business mailing address

19930 HOLLIS AVE
SAINT ALBANS NY
11412-1232
US

V. Phone/Fax

Practice location:
  • Phone: 718-479-3452
  • Fax: 718-776-0708
Mailing address:
  • Phone: 718-479-3452
  • Fax: 718-776-0708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number1233532
License Number StateNY

VIII. Authorized Official

Name: MS. GRACE H COOPER
Title or Position: FOUNDER/ CEO
Credential: RN BSN
Phone: 718-479-3452