Healthcare Provider Details

I. General information

NPI: 1992950976
Provider Name (Legal Business Name): MENORAH HOME AND HOSPITAL FOR AGED AND INFIRM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2008
Last Update Date: 11/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

871 BUSHWICK AVE
BROOKLYN NY
11221-3739
US

IV. Provider business mailing address

871 BUSHWICK AVE
BROOKLYN NY
11221-3739
US

V. Phone/Fax

Practice location:
  • Phone: 718-646-4441
  • Fax:
Mailing address:
  • Phone: 718-646-4441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number7001302N
License Number StateNY

VIII. Authorized Official

Name: MR. ALEXANDER BALKO
Title or Position: SR. VP AND CFO
Credential:
Phone: 718-921-7221