Healthcare Provider Details

I. General information

NPI: 1346230463
Provider Name (Legal Business Name): VICTORIA HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 01/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 N MALCOLM ST
OSSINING NY
10562-3216
US

IV. Provider business mailing address

25 N MALCOLM ST
OSSINING NY
10562-3216
US

V. Phone/Fax

Practice location:
  • Phone: 914-941-2450
  • Fax: 914-941-2531
Mailing address:
  • Phone: 914-941-2450
  • Fax: 914-941-2531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number5905305N
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier00310123
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name: MRS. PHYLLIS A BIANCO
Title or Position: EXECUTIVE DIRECTOR
Credential: CNHA
Phone: 914-941-2450