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NPI Code Detail

MEDICARE: QUEENS BOULEVARD ALP LLC

MEDICARE: QUEENS BOULEVARD ALP LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1310400000XAssisted Living Facility

General Provider Information

NPI Number : 1093351249
Entity Type Code : Organization
Provider Name (Legal Business Name) : QUEENS BOULEVARD ALP LLC
Provider Business Mailing Address
First Line : 7161 159TH ST
Second Line :
City : FLUSHING
State : NY
Zip : 11365-4123
Country : US
Telephone Number : 718-969-7500
Fax Number : 718-303-8244
Provider Business Practice Location Address
First Line : 7161 159TH ST
Second Line :
City : FLUSHING
State : NY
Zip : 11365-4123
Country : US
Telephone Number : 718-969-7500
Fax Number : 718-303-8244
Authorized Official
Title or Position : BUSINESS OFFICE MANAGER
Name : LYUBOV MIKHAYLOVA
Credential :
Telephone Number : 718-969-7500
Provider Enumeration Date : 11/22/2019
Last Update Date : 11/22/2019

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Directions to “QUEENS BOULEVARD ALP LLC ” Practice Location

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