Healthcare Provider Details

I. General information

NPI: 1336650902
Provider Name (Legal Business Name): THE WARTBURG HOME OF THE EVANGELICAL LUTHERAN CHURCH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2017
Last Update Date: 10/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 LINCOLN AVE
NEW ROCHELLE NY
10801-3922
US

IV. Provider business mailing address

1 WARTBURG PL BLDG 6
MOUNT VERNON NY
10552-3821
US

V. Phone/Fax

Practice location:
  • Phone: 914-513-5472
  • Fax: 914-699-2512
Mailing address:
  • Phone: 914-513-5106
  • Fax: 914-699-2512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number5903309N
License Number StateNY

VIII. Authorized Official

Name: MS. EILEEN PANE
Title or Position: DIRECTOR OF BUDGET & REIMBURSEMENT
Credential:
Phone: 914-513-5106