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General NPI Number Information
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NPI Number | 1295964898
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Entity Type | Organization
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Legal Business Name | ISRAELSHINING STAR INCORPORATED
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Dates
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Enumeration Date | 07/06/2009
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Last Update Date | 07/06/2009
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Provider Practice Location Address
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Address Line | 106-35 154TH STREET 2ND FLOOR
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City | JAMAICA
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State | NY
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Zip | 11433-1917
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Country | US
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Telephone | 718-759-8594
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Fax | 718-960-7437
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Provider Business Mailing Address
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Address Line | PO BOX 900093
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City | FAR ROCKAWAY
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State | NY
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Zip | 11690-0093
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Country | US
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Telephone | 718-759-8594
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Fax | 718-960-7437
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Authorized Official
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Title or Position | CEO
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Name | MS. NAOMI PLEASANT ISRAEL
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Credential | LPN
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Telephone | 718-759-8495
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 2205381
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License Number State | NY
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