MEDICARE: CHAPIN HOME FOR THE AGING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	7003351	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467452946
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHAPIN HOME FOR THE AGING

Provider Business Mailing Address
First Line	:	16501 CHAPIN PKWY
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11432-1807
Country	:	US
Telephone Number	:	718-739-2523
Fax Number	:	718-291-0989

Provider Business Practice Location Address
First Line	:	16501 CHAPIN PKWY
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11432-1807
Country	:	US
Telephone Number	:	718-739-2523
Fax Number	:	718-291-0989

Authorized Official
Title or Position	:	CFO
Name	:	WILLIAM B O'HARA
Credential	:	C.P.A., J.D.
Telephone Number	:	718-739-2523

Provider Enumeration Date	:	07/27/2005
Last Update Date	:	10/06/2014

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Practice Location Address:

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1609305911 — NATALIA GOMEZ
Practice Location Address:

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1912892209 — MITHUN KAMAL
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Practice Location Address:

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Directions to “CHAPIN HOME FOR THE AGING ” Practice Location

Language	Start Address	Practice Location

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