Q.V.C.M.H. J-Cap

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

8492 Issued in NY

Legal business name

Q.V.C.M.H. J-CAP

Practice address

11630 Sutphin Blvd
Jamaica, NY 11434-1527

Phone

(718) 322-2500

Fax

(718) 322-1881

NPI assigned

Dec 17, 2015

Organization subpart

Yes

Parent organization

QUEENS VILLAGE COMMITTEE FOR MENTAL HEALTHAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Diane Gonzalez, MSW

Title

Cheif Excutive Officer

Phone

(718) 712-1100

Specialties & licenses 1

Addresses

Other identifiers 1

Part of

Q V Comm for Mental HLTH

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1450310400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1450310400000",
    "number": "1013372051",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11630 SUTPHIN BLVD",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114341527",
            "telephone_number": "718-322-2500",
            "fax_number": "718-322-1881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11630 SUTPHIN BLVD",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114341527",
            "telephone_number": "718-322-2500",
            "fax_number": "718-322-1881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "Q.V.C.M.H. J-CAP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "QUEENS VILLAGE COMMITTEE FOR MENTAL HEALTH",
        "enumeration_date": "2015-12-17",
        "last_updated": "2015-12-17",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ",
        "authorized_official_first_name": "DIANE",
        "authorized_official_title_or_position": "CHEIF EXCUTIVE OFFICER",
        "authorized_official_telephone_number": "718-712-1100",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MSW"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "NY",
            "license": "8492",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "8492",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.