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Organization
ST MARY'S COMMUNITY CARE PROFESSIONAL, CORP.
Active
Organization
ST MARY'S COMMUNITY CARE PROFESSIONAL, CORP.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. FREDERIQUE ALTIDOR (MANAGER)
(718) 281-8688
Entity
Organization
Contact information
Practice address
9131 QUEENS BLVD, SUITE 201, ELMHURST, NY 11373-5555
(718) 819-2713
Mailing address
9131 QUEENS BLVD, SUITE 201, ELMHURST, NY 11373-5555
(718) 819-2713
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01783504
—
NY
Enumeration date
04/10/2007
Last updated
04/12/2013
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