Provider Demographics
NPI:1922169010
Name:FMNH LLC
Entity Type:Organization
Organization Name:FMNH LLC
Other - Org Name:FLUSHING MANOR NURSING & REHABILITATION LTHHC PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICCOBONI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-461-9117
Mailing Address - Street 1:3515 PARSONS BLVD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4236
Mailing Address - Country:US
Mailing Address - Phone:718-961-4300
Mailing Address - Fax:
Practice Address - Street 1:3515 PARSONS BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4236
Practice Address - Country:US
Practice Address - Phone:718-961-4300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7003909L251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02512792Medicaid
NY02512792Medicaid