Provider Demographics
NPI:1063735165
Name:ADVANCED CARE REGISTERED PROFESSIONAL NURSING SERVICES, P.C.
Entity type:Organization
Organization Name:ADVANCED CARE REGISTERED PROFESSIONAL NURSING SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL REGISTERED NURSE
Authorized Official - Prefix:
Authorized Official - First Name:RAISA
Authorized Official - Middle Name:
Authorized Official - Last Name:ACHILDIYEVA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:718-830-0144
Mailing Address - Street 1:6433 98TH ST
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-3321
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6433 98TH ST
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-3321
Practice Address - Country:US
Practice Address - Phone:917-605-1106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-04
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY604857163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty