Healthcare Provider Details

I. General information

NPI: 1891815262
Provider Name (Legal Business Name): SERVANTS OF RELIEF FOR INCURABLE CANCER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 11/01/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 LINDA AVE
HAWTHORNE NY
10532-1362
US

IV. Provider business mailing address

600 LINDA AVE
HAWTHORNE NY
10532-1362
US

V. Phone/Fax

Practice location:
  • Phone: 914-769-0114
  • Fax: 914-769-3916
Mailing address:
  • Phone: 914-769-0114
  • Fax: 914-769-3916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number5957300N
License Number StateNY

VIII. Authorized Official

Name: MARIAN MORALES NAZARIO
Title or Position: ADMINISTRATOR
Credential: NHA
Phone: 914-769-0114