Healthcare Provider Details

I. General information

NPI: 1164451316
Provider Name (Legal Business Name): WARTBURG LUTHERAN HOME FOR THE AGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 SHEFFIELD AVE
BROOKLYN NY
11207-2420
US

IV. Provider business mailing address

50 SHEFFIELD AVE
BROOKLYN NY
11207-2420
US

V. Phone/Fax

Practice location:
  • Phone: 718-345-2273
  • Fax: 718-485-9236
Mailing address:
  • Phone: 718-345-2273
  • Fax: 718-485-9236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number7001364N
License Number StateNY

VIII. Authorized Official

Name: MR. STEVEN REAGAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 718-345-2273