Basic Information
| Provider Information | |||||||||
| NPI: | 1154389211 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HOWE AVENUE NURSING HOME INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | HELEN AND MICHAEL SCHAFFER EXTENDED CARE CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16 GUION PLACE | ||||||||
| Address2: | |||||||||
| City: | NEW ROCHELLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146325000 | ||||||||
| FaxNumber: | 9146371117 | ||||||||
| Practice Location | |||||||||
| Address1: | 16 GUION PLACE | ||||||||
| Address2: | |||||||||
| City: | NEW ROCHELLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146325000 | ||||||||
| FaxNumber: | 9146371117 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2006 | ||||||||
| LastUpdateDate: | 02/13/2013 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SALES | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 9143653702 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 333600000X | 015881 | NY | N | Suppliers | Pharmacy | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 02994374 | 05 | NY | MEDICAID |