NPI 1356930820

State of New York

Organisation Intellectual Disabilities Intermediate Care Facility Queens Village, NY

Practice location

Address: 8045 Winchester Blvd Bldg 8, Queens Village, NY 11427-2194
Phone: (718) 217-5767
Mailing address: 44 Holland Ave, Albany, NY 12208-3411

Authorised official

Name: Earl Raymond Jefferson
Title: Director of Central Operations
Phone: (518) 402-4333

Registered specialties

Intellectual Disabilities Intermediate Care Facility Primary

Nursing & Custodial Care Facilities Taxonomy 315P00000X

Other Intermediate Care Facility, Intellectual Disabilities providers in New York →

Registry record

NPI: 1356930820
Entity type: Organization
NPI issued: 11 Jan 2021
Record last updated: 11 Jan 2021

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.