Healthcare Provider Details

I. General information

NPI: 1376610485
Provider Name (Legal Business Name): CATHOLIC GUARDIAN SOCIETY & HOME BUREAU
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 MARION LN
EAST HAMPTON NY
11937-5193
US

IV. Provider business mailing address

1011 1ST AVE FL 10
NEW YORK NY
10022-4112
US

V. Phone/Fax

Practice location:
  • Phone: 631-324-7141
  • Fax: 631-329-4592
Mailing address:
  • Phone: 212-371-1000
  • Fax: 212-371-1512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number StateNY

VIII. Authorized Official

Name: MR. JOHN FREIN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 212-371-1000