Provider Demographics
NPI:1093351249
Name:QUEENS BOULEVARD ALP LLC
Entity Type:Organization
Organization Name:QUEENS BOULEVARD ALP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LYUBOV
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKHAYLOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-969-7500
Mailing Address - Street 1:7161 159TH ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11365-4123
Mailing Address - Country:US
Mailing Address - Phone:718-969-7500
Mailing Address - Fax:718-303-8244
Practice Address - Street 1:7161 159TH ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11365-4123
Practice Address - Country:US
Practice Address - Phone:718-969-7500
Practice Address - Fax:718-303-8244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-22
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility