Provider Demographics
NPI:1750632329
Name:HUNTINGTON HILLS
Entity Type:Organization
Organization Name:HUNTINGTON HILLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:LISETTE
Authorized Official - Last Name:JEANTY
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE
Authorized Official - Phone:516-284-7042
Mailing Address - Street 1:90 ALDEN AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-1038
Mailing Address - Country:US
Mailing Address - Phone:516-284-7042
Mailing Address - Fax:516-284-7042
Practice Address - Street 1:90 ALDEN AVE
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-1038
Practice Address - Country:US
Practice Address - Phone:516-284-7042
Practice Address - Fax:516-284-7042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY648256251E00000X, 273Y00000X, 314000000X
NY64825314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No251E00000XAgenciesHome Health
No273Y00000XHospital UnitsRehabilitation Unit