Healthcare Provider Details

I. General information

NPI: 1538219761
Provider Name (Legal Business Name): KINGSBRIDGE HEIGHTS LTHHCP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 04/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 W 231ST ST SUITE A
BRONX NY
10463-3992
US

IV. Provider business mailing address

188 WEST 230TH STREET
BRONX NY
10463
US

V. Phone/Fax

Practice location:
  • Phone: 718-796-8165
  • Fax:
Mailing address:
  • Phone: 718-796-8165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. BRUCE ZARETT
Title or Position: ADMINISTRATOR
Credential:
Phone: 718-796-8100