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General NPI Number Information
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NPI Number | 1164060083
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Entity Type | Organization
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Legal Business Name | QUEENS COMMUNITY HOUSE, INC.
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Dates
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Enumeration Date | 12/11/2019
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Last Update Date | 12/11/2019
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Provider Practice Location Address
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Address Line | 108-25 62ND DRIVE
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City | FOREST HILLS
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State | NY
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Zip | 11375-1217
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Country | US
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Telephone | 718-592-5757
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Fax | 718-592-2933
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Provider Business Mailing Address
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Address Line | 108-25 62ND DRIVE
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City | FOREST HILLS
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State | NY
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Zip | 11375-1217
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Country | US
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Telephone | 718-592-5757
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Fax | 718-592-2933
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | KURT FAKIRA
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Credential |
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Telephone | 718-592-5757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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