Provider Demographics
NPI:1225661820
Name:LILY'S PASSION INC
Entity Type:Organization
Organization Name:LILY'S PASSION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/SPECIAL ED TEACHER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LILY
Authorized Official - Middle Name:YADEGAR
Authorized Official - Last Name:BOUTEHSAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MSED
Authorized Official - Phone:718-805-7828
Mailing Address - Street 1:P. O BOX 778
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:134-11 KEW GARDENS RD
Practice Address - Street 2:
Practice Address - City:RICHMAND HILLS
Practice Address - State:NY
Practice Address - Zip Code:11418
Practice Address - Country:US
Practice Address - Phone:718-441-0155
Practice Address - Fax:718-441-0155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-21
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty