MEDICARE: GLENCARA INC

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	251S00000X	Community/Behavioral Health Agency	R 15236	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	P00472672	OTHER	NY	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12151001	OTHER	NY	HIP
2	12151001	OTHER		MULTIPLAN
3	7405842	OTHER	NY	GHI
4	87726	OTHER	NY	INITED BEHAVIORAL HEALTH
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MHS237632	OTHER	NY	VALUE OPTIONS

General Provider Information

NPI Number	:	1811144363
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLENCARA INC

Provider Business Mailing Address
First Line	:	8605 218TH ST
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11427-1922
Country	:	US
Telephone Number	:	718-454-9804
Fax Number	:	718-454-9806

Provider Business Practice Location Address
First Line	:	8605 218TH ST
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11427-1922
Country	:	US
Telephone Number	:	718-454-9804
Fax Number	:	718-454-9806

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SEAN FOLEY
Credential	:	LCSW
Telephone Number	:	718-454-9804

Provider Enumeration Date	:	08/26/2008
Last Update Date	:	08/26/2008

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Directions to “GLENCARA INC ” Practice Location

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