Provider Demographics
NPI:1174233738
Name:IRI: INNOVATIVE RESOURCES FOR INDEPENDENCE
Entity type:Organization
Organization Name:IRI: INNOVATIVE RESOURCES FOR INDEPENDENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SOCIAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:SOPHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LULGJURAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-805-6796
Mailing Address - Street 1:11240 FRANCIS LEWIS BLVD
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11429-2235
Mailing Address - Country:US
Mailing Address - Phone:718-805-6796
Mailing Address - Fax:
Practice Address - Street 1:8045 WINCHESTER BLVD # 004005
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11427-2193
Practice Address - Country:US
Practice Address - Phone:718-805-6796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-05
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities