Healthcare Provider Details

I. General information

NPI: 1083600969
Provider Name (Legal Business Name): ST. JEROMES HEALTH SERVICES CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 84TH ST
BROOKLYN NY
11214-2825
US

IV. Provider business mailing address

1740 84TH ST
BROOKLYN NY
11214-2825
US

V. Phone/Fax

Practice location:
  • Phone: 718-232-3666
  • Fax: 718-259-9180
Mailing address:
  • Phone: 718-232-3666
  • Fax: 718-259-9180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateNY

VIII. Authorized Official

Name: MS. LISA DENIS-SCHIANO
Title or Position: ADMINISTRATOR
Credential: LNHA
Phone: 718-232-3666