Provider Demographics
NPI:1740514165
Name:UNIVERSAL HEALTHCARE SYSTEM LLC
Entity type:Organization
Organization Name:UNIVERSAL HEALTHCARE SYSTEM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MISS
Authorized Official - First Name:KAYTANA
Authorized Official - Middle Name:MONIQE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-557-4477
Mailing Address - Street 1:4328 MATILDA AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-1315
Mailing Address - Country:US
Mailing Address - Phone:917-557-4477
Mailing Address - Fax:
Practice Address - Street 1:4328 MATILDA AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-1315
Practice Address - Country:US
Practice Address - Phone:917-557-4477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-02
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5969633140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric