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General NPI Number Information
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NPI Number | 1790031268
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Entity Type | Organization
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Legal Business Name | CAROL LOURDES CENTER INC.
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Dates
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Enumeration Date | 08/02/2012
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Last Update Date | 08/02/2012
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Provider Practice Location Address
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Address Line | 6125 98TH ST APT. 16H
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City | REGO PARK
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State | NY
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Zip | 11374-1419
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Country | US
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Telephone | 917-478-8417
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 103
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City | LAKE ARIEL
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State | PA
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Zip | 18436-0103
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Country | US
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Telephone | 917-478-8417
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MISS ELSIE M RENTA
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Credential | MS. ED.
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Telephone | 917-478-8417
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 1846740
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License Number State | NY
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