Provider Demographics
NPI:1396825543
Name:OZANAM HALL OF QUEENS NURSING HOME, INC
Entity Type:Organization
Organization Name:OZANAM HALL OF QUEENS NURSING HOME, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWDEN
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:718-423-2000
Mailing Address - Street 1:4241 201ST ST
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-2550
Mailing Address - Country:US
Mailing Address - Phone:718-423-2000
Mailing Address - Fax:718-971-2071
Practice Address - Street 1:4241 201ST ST
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2550
Practice Address - Country:US
Practice Address - Phone:718-423-2000
Practice Address - Fax:718-971-2071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1670OtherPFI NUMBER
NY1396825543OtherNPI
NY7003306NMedicaid
NY00309691OtherMEDICAID PROVIDER NUMBER
NY1396825543OtherNPI
NY335363Medicare ID - Type Unspecified