Provider Demographics
NPI:1730371899
Name:QUEENS CENTER FOR REHABILITATION RESIDENTIAL HEALTHCARE
Entity type:Organization
Organization Name:QUEENS CENTER FOR REHABILITATION RESIDENTIAL HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:ALICIA
Authorized Official - Last Name:PANTOJA
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:813-943-5289
Mailing Address - Street 1:8560 160TH ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-1722
Mailing Address - Country:US
Mailing Address - Phone:717-523-7202
Mailing Address - Fax:
Practice Address - Street 1:15715 19TH AVE
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-3820
Practice Address - Country:US
Practice Address - Phone:718-746-0400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0028101313M00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility