Organization
BEACON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORRAINE L BEATON-FUNG BS/CDN/CLC (NUTRITIONIST)
(917) 750-4929
Entity
Organization
Contact information
Practice address
14838 HUXLEY ST, ROSEDALE, NY 11422-2720
(917) 750-4929
Mailing address
14838 HUXLEY ST, ROSEDALE, NY 11422-2720
(917) 750-4929
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
004244-1
NY
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
004244-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004244-1
AGENCY
NY
Enumeration date
07/15/2015
Last updated
07/15/2015
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