Provider Demographics
NPI:1861905762
Name:NEXT LEVEL PROFESSSIONAL SERVICES
Entity type:Organization
Organization Name:NEXT LEVEL PROFESSSIONAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAJUANA
Authorized Official - Middle Name:PATRICE
Authorized Official - Last Name:JAMES-JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:770-203-5095
Mailing Address - Street 1:2216 NEW HAVEN AVE APT 7N
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-2562
Mailing Address - Country:US
Mailing Address - Phone:770-203-5095
Mailing Address - Fax:
Practice Address - Street 1:70 E SUNRISE HWY STE 500
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-1233
Practice Address - Country:US
Practice Address - Phone:770-203-5095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEXT LEVEL PROFESSIONAL SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1205225612Medicaid