Basic Information
| Provider Information | |||||||||
| NPI: | 1730371899 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | QUEENS CENTER FOR REHABILITATION RESIDENTIAL HEALTHCARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8560 160TH ST | ||||||||
| Address2: | |||||||||
| City: | JAMAICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114321722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175237202 | ||||||||
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| Practice Location | |||||||||
| Address1: | 15715 19TH AVE | ||||||||
| Address2: | |||||||||
| City: | WHITESTONE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113573820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187460400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2007 | ||||||||
| LastUpdateDate: | 08/13/2007 | ||||||||
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| AuthorizedOfficialLastName: | PANTOJA | ||||||||
| AuthorizedOfficialFirstName: | CARMEN | ||||||||
| AuthorizedOfficialMiddleName: | ALICIA | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICAL THERAPIST ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 8139435289 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | PTA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 313M00000X | 0028101 | NY | N | Nursing & Custodial Care Facilities | Nursing Facility/Intermediate Care Facility | 251E00000X | 0028101 | NY | Y | Agencies | Home Health |
No ID Information.