Basic Information
| Provider Information | |||||||||
| NPI: | 1275149619 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAMILY SERVICE LEAQUE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 790 PARK AVE | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117434516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314706788 | ||||||||
| FaxNumber: | 6314274268 | ||||||||
| Practice Location | |||||||||
| Address1: | 790 PARK AVE | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117434516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314706788 | ||||||||
| FaxNumber: | 6314274268 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2020 | ||||||||
| LastUpdateDate: | 09/21/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | PIERRE | ||||||||
| AuthorizedOfficialFirstName: | NIRVA | ||||||||
| AuthorizedOfficialMiddleName: | MELLISA | ||||||||
| AuthorizedOfficialTitleorPosition: | REGISTERED NURSE | ||||||||
| AuthorizedOfficialTelephone: | 3474539477 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | RN | ||||||||
| NPICertificationDate: | 09/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251J00000X | N | Agencies | Nursing Care | 313M00000X | N | Nursing & Custodial Care Facilities | Nursing Facility/Intermediate Care Facility | 251K00000X | Y | Agencies | Public Health or Welfare |
No ID Information.