=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093139222
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MJHS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2014
-----------------------------------------------------
Last Update Date | 02/07/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 39 BROADWAY SUITE 200
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10006-3003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-649-5556
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 39 BROADWAY SUITE 200
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10006-3003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-649-5556
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | DEBORAH MCDOUGALD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 212-649-5556
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 072223
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------