Healthcare Provider Details

I. General information

NPI: 1558819862
Provider Name (Legal Business Name): FORT TRYON REHABILITATION & HEALTH CARE FACILITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2016
Last Update Date: 09/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W 190TH ST
NEW YORK NY
10040-3802
US

IV. Provider business mailing address

801 W 190TH ST
NEW YORK NY
10040-3802
US

V. Phone/Fax

Practice location:
  • Phone: 212-543-6400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number7002359N
License Number StateNY

VIII. Authorized Official

Name: HELEN WEBSTER
Title or Position: CEO
Credential:
Phone: 718-670-6300