1467435669 NPI number — HEBREW HOME FOR THE AGED AT RIVERDALE

Table of content: (NPI 1467435669)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467435669 NPI number — HEBREW HOME FOR THE AGED AT RIVERDALE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEBREW HOME FOR THE AGED AT RIVERDALE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ELDERSERVE CERTIFIED HOME HEALTH CARE AGENCY/ RIVERSPRING CHHA
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467435669
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5901 PALISADE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10471-1205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-581-1313
Provider Business Mailing Address Fax Number:
187-709-4277

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
94 W. 225TH STREET
Provider Second Line Business Practice Location Address:
ATT: CARL WILLNER
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10463
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-249-0500
Provider Business Practice Location Address Fax Number:
914-885-1079
Provider Enumeration Date:
11/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WILLNER
Authorized Official First Name:
CARL
Authorized Official Middle Name:
Authorized Official Title or Position:
SENIOR VICE PRESIDENT, FINANCE
Authorized Official Telephone Number:
718-581-1000

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  7000909C , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01207950 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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