Maxine Rosemarie Harris

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

460234-1 Issued in NY

Practice address

220-08 109 Avenue
Queens Village, NY 11429

Phone

(917) 226-7249

NPI assigned

May 16, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Heavenly Creations Adult Day Care LLC

  • Adult Day Care Clinic/Center
  • Queens Village, NY
  • NPI 1871912113
  NPD (past) Authorized official

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

{
    "created_epoch": "1337126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1337126400000",
    "number": "1023377611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22008 109TH AVE",
            "city": "QUEENS VILLAGE",
            "state": "NY",
            "postal_code": "114292515",
            "telephone_number": "917-226-7249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220-08 109 AVENUE",
            "city": "QUEENS VILLAGE",
            "state": "NY",
            "postal_code": "11429",
            "telephone_number": "917-226-7249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "MAXINE",
        "middle_name": "ROSEMARIE",
        "name_prefix": "Miss",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-05-16",
        "last_updated": "2012-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NY",
            "license": "460234-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "TF7175290",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jawad Ul Haque
• Deneil Angella Hardy
• Omer Haroon, M.D.
• Mandalee Harriott
• Andrea Harris
• Shaneequa Harrison
• Cindy Harryram, NP
• Jenelle Hartley, ED.M
• Keneisha Haughton
• Kadian Haye-Odipo, LMSW

• Adult Care Home Facility in Queens Village, NY
• Providers in Queens Village, NY by specialty
• Adult Care Home Facility in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2012; 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.