# PRIVATE DUTY NURSE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386812485
- **Authorized official:** MS. CARDENE WALLACE LPN (LPN)
- **Authorized official phone:** (914) 433-5331

## Contact information

- **Practice address:** 106 WINTHROP AVE, 2ND FLOOR, NEW ROCHELLE, NY 10801-3313
- **Practice address phone:** (914) 433-5331
- **Mailing address:** 106 WINTHROP AVE, 2ND FLOOR, NEW ROCHELLE, NY 10801
- **Mailing address phone:** (914) 433-5331

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320700000X | Physical Disabilities Residential Treatment Facility | 169322-1 | NY | Yes |

## Other

- **Enumeration date:** 02/12/2008
- **Last updated:** 02/12/2008