Organization
SHINING LEAF IPA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JENI WALLACE (VICE PRESIDENT OF OPERATIONS)
(718) 269-4888
Entity
Organization
Contact information
Practice address
2900 BRAGG ST, BROOKLYN, NY 11235-1144
(718) 268-4888
Mailing address
2900 BRAGG ST, BROOKLYN, NY 11235-1144
(718) 268-4888
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Enumeration date
08/08/2014
Last updated
08/08/2014
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