Organization
FAMILY SERVICE LEAQUE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NIRVA MELLISA PIERRE RN (REGISTERED NURSE)
(347) 453-9477
Entity
Organization
Contact information
Practice address
790 PARK AVE, HUNTINGTON, NY 11743-4516
(631) 470-6788
(631) 427-4268
Mailing address
790 PARK AVE, HUNTINGTON, NY 11743-4516
(631) 470-6788
(631) 427-4268
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
—
—
251K00000X
Public Health or Welfare Agency
Primary
—
—
313M00000X
Nursing Facility/Intermediate Care Facility
—
—
Other
Enumeration date
09/21/2020
Last updated
09/21/2020
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