Basic Information
| Provider Information | |||||||||
| NPI: | 1023097698 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARMEL RICHMOND NURSING HOME, INC. | ||||||||
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| OtherOrganizationName: | CARMEL RICHMOND HEALTH CARE AND REHABILITATION CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 88 OLD TOWN RD | ||||||||
| Address2: | |||||||||
| City: | STATEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 103044212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6466334774 | ||||||||
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| Practice Location | |||||||||
| Address1: | 88 OLD TOWN ROAD | ||||||||
| Address2: | |||||||||
| City: | STATEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186688500 | ||||||||
| FaxNumber: | 7189875228 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2006 | ||||||||
| LastUpdateDate: | 12/18/2014 | ||||||||
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| AuthorizedOfficialLastName: | COVONE | ||||||||
| AuthorizedOfficialFirstName: | ANNMARIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | SRVP CFO | ||||||||
| AuthorizedOfficialTelephone: | 6466334702 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 7004310N | NY | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 01383944 | 05 | NY | MEDICAID | 00308690 | 05 | NY | MEDICAID |