Basic Information
| Provider Information | |||||||||
| NPI: | 1023576303 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MAJESTIC CARE OF WHITEHALL LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 158-13 72ND AVENUE | ||||||||
| Address2: | |||||||||
| City: | FLUSHING | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145018271 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4805 LANGLEY AVE | ||||||||
| Address2: | |||||||||
| City: | WHITEHALL | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432136125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145018271 | ||||||||
| FaxNumber: | 6148613033 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2019 | ||||||||
| LastUpdateDate: | 03/06/2019 | ||||||||
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| AuthorizedOfficialLastName: | WILLIAMS | ||||||||
| AuthorizedOfficialFirstName: | HAYLEY | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | ATTORNEY | ||||||||
| AuthorizedOfficialTelephone: | 2167063936 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 2288N | 01 | OH | LICENSURE | OTHER |