=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669717427
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABSOLUTE HEALTHCARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2012
-----------------------------------------------------
Last Update Date | 12/05/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 172 LAKE AVE
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10303-2724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-330-0896
-----------------------------------------------------
Fax | 267-393-8199
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 172 LAKE AVE
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10303-2724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-330-0896
-----------------------------------------------------
Fax | 267-393-8199
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED PRACTICAL NURSE
-----------------------------------------------------
Name | MR. JUDE U IFEBI
-----------------------------------------------------
Credential | LPN
-----------------------------------------------------
Telephone | 646-330-0896
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 313M00000X
-----------------------------------------------------
Taxonomy Name | Nursing Facility/Intermediate Care Facility
-----------------------------------------------------
License Number | 296840
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------