Provider Demographics
NPI:1376575977
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:631-232-6030
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 1:888 VETERANS MEMORIAL HWY
Practice Address - Street 2:SUITE 210
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-2940
Practice Address - Country:US
Practice Address - Phone:631-232-6030
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
112645333OtherG2
202035308OtherG2
NY01047281Medicaid
337232OtherG2
7695046OtherG2
1166983OtherG2
227654OtherG2
000400510009Other1B
145040OtherG2
19001OtherG2
565800OtherG2
6002016OtherG2
040401001283OtherG2
116529OtherG2
004564OtherG2
337224OtherG2
866452OtherG2
94693OtherG2
112256479OtherG2
202035308OtherG2