| Organization Name: | LPN |
| NPI Number: | 1255733978 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | HEATHER ROSALIA (LICENSED PRACTICAL NURSE) |
| Mailing Address: | 15 Lacrosse Rd Mastic Beach |
| State: | NY US |
| Postal Code: | 119514901 |
| Phone Number: | 6317296844 |
| Fax Number: | |
| NPI Enumeration Date: | 09/24/2014 |
| NPI Last Update Date: | 09/24/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 253Z00000X |
| License Number: | 3141511 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | In Home Supportive Care |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An In Home Supportive Care Agency provides services in the patient |