Healthcare Provider Details

I. General information

NPI: 1730371899
Provider Name (Legal Business Name): QUEENS CENTER FOR REHABILITATION RESIDENTIAL HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 08/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15715 19TH AVE
WHITESTONE NY
11357-3820
US

IV. Provider business mailing address

8560 160TH ST
JAMAICA NY
11432-1722
US

V. Phone/Fax

Practice location:
  • Phone: 718-746-0400
  • Fax:
Mailing address:
  • Phone: 717-523-7202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number0028101
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number0028101
License Number StateNY

VIII. Authorized Official

Name: MRS. CARMEN ALICIA PANTOJA
Title or Position: PHYSICAL THERAPIST ASSISTANT
Credential: PTA
Phone: 813-943-5289