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General NPI Number Information
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NPI Number | 1518200757
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Entity Type | Organization
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Legal Business Name | QUEENS LONG ISLAND CERTIFIED HOME HEALTH AGENCY LLC
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Dates
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Enumeration Date | 04/05/2013
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Last Update Date | 01/28/2015
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Provider Practice Location Address
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Address Line | 3625 PARSONS BLVD
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City | FLUSHING
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State | NY
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Zip | 11354-5938
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Country | US
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Telephone | 718-461-9115
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Fax |
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Provider Business Mailing Address
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Address Line | 3625 PARSONS BLVD
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City | FLUSHING
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State | NY
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Zip | 11354-5938
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Country | US
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Telephone | 718-461-9115
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MICHAEL BENENSON
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Credential |
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Telephone | 718-461-9115
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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 |
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License Number State |
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