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General NPI Number Information
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NPI Number | 1376943761
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Entity Type | Organization
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Legal Business Name | QUEENS BLVD EXT CARE FACILITY MANAGEMENT LLC
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Dates
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Enumeration Date | 09/04/2014
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Last Update Date | 12/15/2021
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Provider Practice Location Address
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Address Line | 6111 QUEENS BLVD
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City | WOODSIDE
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State | NY
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Zip | 11377-4965
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Country | US
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Telephone | 718-205-0298
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Fax |
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Provider Business Mailing Address
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Address Line | 6111 QUEENS BLVD
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City | WOODSIDE
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State | NY
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Zip | 11377-4965
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Country | US
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Telephone | 718-205-0298
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MR. JOSEPH MALONE
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Credential |
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Telephone | 718-205-0298
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 703410N
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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