Organization Name: | PERSONAL CARE NP ADULT HEALTH PRACTICE |
NPI Number: | 1063871523 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RALPH EDOUARD (NURSE PRACTIONER) |
Mailing Address: | 19105 Jamaica Ave Hollis |
State: | NY US |
Postal Code: | 114232527 |
Phone Number: | 9179071455 |
Fax Number: | 3474549964 |
NPI Enumeration Date: | 02/12/2016 |
NPI Last Update Date: | 02/12/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320800000X |
License Number: | 3053411 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Community Based Residential Treatment Facility, Mental Illness |
Taxonomy Specialization: | |
Taxonomy Definition: | A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |