Provider Demographics
NPI:1295194116
Name:INDIVIDUALIZED FAMILY CARE LLC
Entity type:Organization
Organization Name:INDIVIDUALIZED FAMILY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YOCHEVED
Authorized Official - Middle Name:
Authorized Official - Last Name:POLISHUK
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:347-369-2733
Mailing Address - Street 1:12-22 30TH AVE
Mailing Address - Street 2:4 H
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102
Mailing Address - Country:US
Mailing Address - Phone:347-369-2733
Mailing Address - Fax:
Practice Address - Street 1:12-22 30TH AVE
Practice Address - Street 2:APT 4H
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102
Practice Address - Country:US
Practice Address - Phone:347-369-2733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-19
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health