Provider Demographics
NPI:1164060083
Name:QUEENS COMMUNITY HOUSE, INC.
Entity Type:Organization
Organization Name:QUEENS COMMUNITY HOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:FAKIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-592-5757
Mailing Address - Street 1:108-25 62ND DRIVE
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1217
Mailing Address - Country:US
Mailing Address - Phone:718-592-5757
Mailing Address - Fax:718-592-2933
Practice Address - Street 1:108-25 62ND DRIVE
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1217
Practice Address - Country:US
Practice Address - Phone:718-592-5757
Practice Address - Fax:718-592-2933
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QUEENS COMMUNITY HOUSE INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care