Provider Demographics
NPI:1114959988
Name:QC-MEDI NEW YORK, INC.
Entity Type:Organization
Organization Name:QC-MEDI NEW YORK, INC.
Other - Org Name:CENTERWELL HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED SIGNATORY
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-962-0102
Mailing Address - Street 1:6330 SPRINT PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1157
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11849 E CORNING RD
Practice Address - Street 2:SUITE 108
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-3695
Practice Address - Country:US
Practice Address - Phone:607-962-0102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
00011327202OtherG2
112645333OtherG2
120243OtherG2
520115OtherG2
335394OtherG2
337224OtherG2
013100POtherG2
11225647902OtherG2
116529OtherG2
337292OtherG2
000400510005Other1B
098251OtherG2
202035301OtherG2
000161506OtherG2
NY01447763Medicaid
112256479OtherG2
112802024OtherG2
7215344OtherG2
520115OtherG2
337292OtherG2