Healthcare Provider Details

I. General information

NPI: 1467435669
Provider Name (Legal Business Name): HEBREW HOME FOR THE AGED AT RIVERDALE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 W. 225TH STREET ATT: CARL WILLNER
BRONX NY
10463
US

IV. Provider business mailing address

5901 PALISADE AVE
BRONX NY
10471-1205
US

V. Phone/Fax

Practice location:
  • Phone: 212-249-0500
  • Fax: 914-885-1079
Mailing address:
  • Phone: 718-581-1313
  • Fax: 187-709-4277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number7000909C
License Number StateNY

VIII. Authorized Official

Name: CARL WILLNER
Title or Position: SENIOR VICE PRESIDENT, FINANCE
Credential:
Phone: 718-581-1000