Provider Demographics
NPI:1306229489
Name:QUEENS HOMECARE AGENCY
Entity Type:Organization
Organization Name:QUEENS HOMECARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-324-6973
Mailing Address - Street 1:PO BOX 686
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-0686
Mailing Address - Country:US
Mailing Address - Phone:917-324-6973
Mailing Address - Fax:
Practice Address - Street 1:2 E BROADWAY STE 802
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-1094
Practice Address - Country:US
Practice Address - Phone:917-324-6973
Practice Address - Fax:347-368-0618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1937L001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health