MEDICARE: UNIVERSAL HEALTHCARE SYSTEM 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
1	3140N1450X	Pediatric Skilled Nursing Facility	596963	NY

General Provider Information

NPI Number	:	1740514165
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSAL HEALTHCARE SYSTEM LLC

Provider Business Mailing Address
First Line	:	4328 MATILDA AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-1315
Country	:	US
Telephone Number	:	917-557-4477
Fax Number	:

Provider Business Practice Location Address
First Line	:	4328 MATILDA AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-1315
Country	:	US
Telephone Number	:	917-557-4477
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED NURSE
Name	:	MISS KAYTANA MONIQE JOHNSON
Credential	:
Telephone Number	:	917-557-4477

Provider Enumeration Date	:	10/02/2009
Last Update Date	:	10/02/2009

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