Basic Information
| Provider Information | |||||||||
| NPI: | 1598744146 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TERENCE CARDINAL COOKE HEALTH CARE CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1249 5TH AVE | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100294413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6466334774 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1249 5TH AVENUE | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6466334702 | ||||||||
| FaxNumber: | 6466334701 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2006 | ||||||||
| LastUpdateDate: | 08/15/2008 | ||||||||
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| AuthorizedOfficialLastName: | COVONE | ||||||||
| AuthorizedOfficialFirstName: | ANNMARIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | SR VP CFO | ||||||||
| AuthorizedOfficialTelephone: | 6466334702 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BN1400X | NY | N | Suppliers | Durable Medical Equipment & Medical Supplies | Nursing Facility Supplies | 332BP3500X | NY | N | Suppliers | Durable Medical Equipment & Medical Supplies | Parenteral & Enteral Nutrition | 314000000X | 7002345N | NY | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 00355202 | 05 | NY | MEDICAID | 00798123 | 05 | NY | MEDICAID |