NPIMap

Organization Active NPI

St Mary'S Community Care Professional, Corp.

  • Home Health Agency
  • Elmhurst, NY
National Provider Identifier
1063635142
Registry record updated Apr 12, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
ST MARY'S COMMUNITY CARE PROFESSIONAL, CORP.
Practice address
9131 Queens Blvd
Suite 201
Elmhurst, NY 11373-5555
Phone
(718) 819-2713
NPI assigned
Apr 10, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2013

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

Authorized official

Name
Ms. Frederique Altidor
Title
Manager
Phone
(718) 281-8688

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

9131 Queens Blvd
Suite 201
Elmhurst, NY 11373-5555

Mailing address

9131 Queens Blvd
Suite 201
Elmhurst, NY 11373-5555
Phone (718) 819-2713

Other identifiers 1

IdentifierTypeStateIssuer
01783504MedicaidNY

National Provider Directory

National Provider Directory
Tax ID family
St Mary'S Community Care Professional2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365724800000",
    "number": "1063635142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9131 QUEENS BLVD",
            "address_2": "SUITE 201",
            "city": "ELMHURST",
            "state": "NY",
            "postal_code": "113735555",
            "telephone_number": "718-819-2713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9131 QUEENS BLVD",
            "address_2": "SUITE 201",
            "city": "ELMHURST",
            "state": "NY",
            "postal_code": "113735555",
            "telephone_number": "718-819-2713"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST MARY'S COMMUNITY CARE PROFESSIONAL, CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-10",
        "last_updated": "2013-04-12",
        "status": "A",
        "authorized_official_last_name": "ALTIDOR",
        "authorized_official_first_name": "FREDERIQUE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "718-281-8688",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01783504",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elmhurst, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2013; 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.