Basic Information
| Provider Information | |||||||||
| NPI: | 1295108736 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | QSAC, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 253 W 35TH ST | ||||||||
| Address2: | 16TH FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100011907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122445560 | ||||||||
| FaxNumber: | 2122445561 | ||||||||
| Practice Location | |||||||||
| Address1: | 11216 200TH ST | ||||||||
| Address2: | |||||||||
| City: | SAINT ALBANS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114122128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182170285 | ||||||||
| FaxNumber: | 7182179491 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2015 | ||||||||
| LastUpdateDate: | 11/05/2015 | ||||||||
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| AuthorizedOfficialLastName: | MAFFEI | ||||||||
| AuthorizedOfficialFirstName: | GARY | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2122445560 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MPA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310500000X | 7276451 | NY | Y | Nursing & Custodial Care Facilities | Intermediate Care Facility, Mental Illness |
No ID Information.