Healthcare Provider Details

I. General information

NPI: 1790879146
Provider Name (Legal Business Name): METHODIST CHURCH HOME FOR THE AGED IN THE CITY OF NEW YORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 03/09/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4499 MANHATTAN COLLEGE PARKWAY
BRONX NY
10471
US

IV. Provider business mailing address

4499 MANHATTAN COLLEGE PARKWAY
BRONX NY
10471
US

V. Phone/Fax

Practice location:
  • Phone: 718-548-5100
  • Fax: 718-548-3147
Mailing address:
  • Phone: 718-548-5100
  • Fax: 718-548-3147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number04740
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. MARIA ELENA PEREZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 718-548-5100