Provider Demographics
NPI:1558037481
Name:QUEENSBRIDGE HOSPICE, INC.
Entity Type:Organization
Organization Name:QUEENSBRIDGE HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ADWOA SERWA
Authorized Official - Middle Name:
Authorized Official - Last Name:OSEI NYARKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-313-9592
Mailing Address - Street 1:6400 E WASHINGTON BLVD STE 107G
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:CA
Mailing Address - Zip Code:90040-1820
Mailing Address - Country:US
Mailing Address - Phone:747-201-7424
Mailing Address - Fax:747-201-7423
Practice Address - Street 1:6400 E WASHINGTON BLVD STE 107G
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90040-1820
Practice Address - Country:US
Practice Address - Phone:747-201-7424
Practice Address - Fax:747-201-7423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No251B00000XAgenciesCase Management
No251F00000XAgenciesHome Infusion