Healthcare Provider Details

I. General information

NPI: 1730415399
Provider Name (Legal Business Name): FEDCAP REHABILITATION SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2009
Last Update Date: 02/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 WASHINGTON AVE
BRONX NY
10456-6619
US

IV. Provider business mailing address

211 WEST 14TH STREET
NEW YORK NY
10011
US

V. Phone/Fax

Practice location:
  • Phone: 718-764-5127
  • Fax: 718-585-4307
Mailing address:
  • Phone: 212-727-4200
  • Fax: 212-727-4374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. CHRISTINE MCMAHON
Title or Position: PRESIDENT/CEO
Credential:
Phone: 212-727-4275