Basic Information
| Provider Information | |||||||||
| NPI: | 1104373133 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JEWISH HOME LIFECARE, MANHATTAN | ||||||||
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| OtherOrganizationName: | THE NEW JEWISH HOME, BRONX ADHC | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 W 106TH ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100253923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2128705000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2545 UNIVERSITY AVE | ||||||||
| Address2: | ADULT DAY HEALTH CENTER | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104684066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184101220 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2016 | ||||||||
| LastUpdateDate: | 09/07/2016 | ||||||||
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| AuthorizedOfficialLastName: | WEINER | ||||||||
| AuthorizedOfficialFirstName: | AUDREY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2128704600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA0600X | 7002340N | NY | Y | Ambulatory Health Care Facilities | Clinic/Center | Adult Day Care |
No ID Information.