Provider Demographics
NPI:1346864212
Name:QUEENSHADE LLC
Entity type:Organization
Organization Name:QUEENSHADE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:FOLASHADE
Authorized Official - Middle Name:E
Authorized Official - Last Name:ADEBIYI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:908-656-4387
Mailing Address - Street 1:33 RICH ST
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-2020
Mailing Address - Country:US
Mailing Address - Phone:908-656-4387
Mailing Address - Fax:
Practice Address - Street 1:1200 CLINTON AVE STE 100C1
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-2070
Practice Address - Country:US
Practice Address - Phone:862-576-3281
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-05
Last Update Date:2025-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health