Provider Demographics
NPI:1760414171
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:516-746-8013
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 1:865 MERRICK AVE
Practice Address - Street 2:SUITE 340 SOUTH
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-6695
Practice Address - Country:US
Practice Address - Phone:516-746-8013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT003109635Medicaid
NY01447745Medicaid
040401001283OtherG2
1017399OtherG2
18614OtherG2
020100OtherG2
337289OtherG2
3700135OtherG2
7695046OtherG2
866454OtherG2
4411OtherG2
116529OtherG2
397422OtherG2
235397OtherG2
565800OtherG2
702022OtherG2
000400510008Other1B
112645333OtherG2
111171OtherG2
397422OtherG2