Basic Information
| Provider Information | |||||||||
| NPI: | 1285913707 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTERIM HEALTHCARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 363 PARKVIEW AVE APT 2J | ||||||||
| Address2: | |||||||||
| City: | YONKERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 107105158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9143205681 | ||||||||
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| Practice Location | |||||||||
| Address1: | 363 PARKVIEW AVE APT 2J | ||||||||
| Address2: | |||||||||
| City: | YONKERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 107105158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9143205681 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2011 | ||||||||
| LastUpdateDate: | 08/15/2011 | ||||||||
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| AuthorizedOfficialLastName: | ALEXANDER | ||||||||
| AuthorizedOfficialFirstName: | RENNEE | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | FIELD SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 9143205681 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | II | ||||||||
| AuthorizedOfficialCredential: | RN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 357676-1 | NY | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.