Healthcare Provider Details

I. General information

NPI: 1467526160
Provider Name (Legal Business Name): JEWISH HOME LIFECARE, MANHATTAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 10/13/2022
Certification Date: 10/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 WATERS PL
BRONX NY
10461-2728
US

IV. Provider business mailing address

1200 WATERS PL
BRONX NY
10461-2728
US

V. Phone/Fax

Practice location:
  • Phone: 718-410-1220
  • Fax:
Mailing address:
  • Phone: 718-410-1220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number7002340N
License Number StateNY

VIII. Authorized Official

Name: DANA PENNY
Title or Position: CHIEF COMPLIANCE OFFICER
Credential:
Phone: 212-870-4752