Provider Demographics
NPI:1912939489
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:315-461-0209
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 1:115 CONTINUUM DR STE 2E
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-4387
Practice Address - Country:US
Practice Address - Phone:315-461-0209
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
120243OtherG2
565800OtherG2
040401001283OtherG2
520119OtherG2
00011327202OtherG2
000161506OtherG2
112645333OtherG2
112802024OtherG2
0003302145OtherG2
7215344OtherG2
335394OtherG2
337255OtherG2
4411OtherG2
112256479OtherG2
000900434000Other1B
NY01085501Medicaid
116529OtherG2
317065OtherG2
7215344OtherG2
565800OtherG2