Healthcare Provider Details

I. General information

NPI: 1164536660
Provider Name (Legal Business Name): BROOKLYN UNITED METHODIST CHURCH HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 01/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1485 DUMONT AVE
BROOKLYN NY
11208-4705
US

IV. Provider business mailing address

1485 DUMONT AVE
BROOKLYN NY
11208-4705
US

V. Phone/Fax

Practice location:
  • Phone: 718-827-4500
  • Fax: 718-827-7719
Mailing address:
  • Phone: 718-827-4500
  • Fax: 718-827-7719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number7001308N
License Number StateNY

VIII. Authorized Official

Name: MS. SANDRA D PITTERSON
Title or Position: CFO
Credential:
Phone: 718-827-4500