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General NPI Number Information
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NPI Number | 1710698311
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Entity Type | Organization
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Legal Business Name | ANNA M SENIOR CARE CENTER INC
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Dates
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Enumeration Date | 12/06/2022
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Last Update Date | 12/06/2022
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Provider Practice Location Address
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Address Line | 15612 107TH AVE
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City | JAMAICA
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State | NY
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Zip | 11433-2068
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Country | US
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Telephone | 347-494-9362
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Fax |
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Provider Business Mailing Address
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Address Line | 15612 107TH AVE
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City | JAMAICA
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State | NY
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Zip | 11433-2068
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Country | US
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Telephone | 347-494-9362
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Fax |
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Authorized Official
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Title or Position | CEO/FOUNDER
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Name | TAKISHA THOMAS
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Credential |
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Telephone | 347-494-9362
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State |
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