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General NPI Number Information
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NPI Number | 1821467788
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Entity Type | Organization
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Legal Business Name | CREEDMOOR PSYCHIATRIC CENTER
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Dates
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Enumeration Date | 09/22/2015
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Last Update Date | 09/22/2015
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Provider Practice Location Address
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Address Line | 137 HEATHCOTE RD
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City | ELMONT
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State | NY
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Zip | 11003-2005
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Country | US
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Telephone | 516-305-5787
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Fax |
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Provider Business Mailing Address
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Address Line | 137 HEATHCOTE RD
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City | ELMONT
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State | NY
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Zip | 11003-2005
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Country | US
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Telephone | 516-305-5787
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Fax |
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Authorized Official
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Title or Position | REGISTERED NURSE
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Name | MRS. MARIE GERMAINE LAROQUE
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Credential | REGISTERED NURSE
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Telephone | 516-305-5787
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 567790
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 22-567790
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License Number State | NY
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