MEDICARE: UNITED ODD FELLOW AND REBEKAH HOME

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	7000314N	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	:	1801898192
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNITED ODD FELLOW AND REBEKAH HOME

Provider Business Mailing Address
First Line	:	1070 HAVEMEYER AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-5310
Country	:	US
Telephone Number	:	718-863-6200
Fax Number	:	914-530-2170

Provider Business Practice Location Address
First Line	:	1072 HAVEMEYER AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-5310
Country	:	US
Telephone Number	:	718-863-6200
Fax Number	:	718-828-0760

Authorized Official
Title or Position	:	DIRECTOR OF FINANCE
Name	:	MR. MICHAEL FELBERG
Credential	:
Telephone Number	:	718-863-6200

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	11/11/2021

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