Provider Demographics
NPI:1518200757
Name:QUEENS LONG ISLAND CERTIFIED HOME HEALTH AGENCY LLC
Entity Type:Organization
Organization Name:QUEENS LONG ISLAND CERTIFIED HOME HEALTH AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BENENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-461-9115
Mailing Address - Street 1:3625 PARSONS BLVD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5938
Mailing Address - Country:US
Mailing Address - Phone:718-461-9115
Mailing Address - Fax:
Practice Address - Street 1:3625 PARSONS BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5938
Practice Address - Country:US
Practice Address - Phone:718-461-9115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-05
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health