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NPI Code Detail

MEDICARE: BOULEVARD ALP LHSCA OPERATIONS

MEDICARE: BOULEVARD ALP LHSCA OPERATIONS
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
1251E00000XHome Health Agency

General Provider Information

NPI Number : 1710427323
Entity Type Code : Organization
Provider Name (Legal Business Name) : BOULEVARD ALP LHSCA OPERATIONS
Provider Business Mailing Address
First Line : 7161 159TH ST
Second Line :
City : FRESH MEADOWS
State : NY
Zip : 11365-4123
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7161 159TH ST
Second Line :
City : FRESH MEADOWS
State : NY
Zip : 11365-4123
Country : US
Telephone Number : 718-269-5165
Fax Number : 718-269-5166
Authorized Official
Title or Position : ADMIN
Name : MICHAEL MARX
Credential :
Telephone Number : 516-319-5260
Provider Enumeration Date : 03/01/2017
Last Update Date : 03/01/2017

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Directions to “BOULEVARD ALP LHSCA OPERATIONS ” Practice Location

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