Healthcare Provider Details

I. General information

NPI: 1285633354
Provider Name (Legal Business Name): MIRIAM OSBORN MEMORIAL HOME ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THEALL RD
RYE NY
10580-1406
US

IV. Provider business mailing address

101 THEALL RD
RYE NY
10580-1406
US

V. Phone/Fax

Practice location:
  • Phone: 914-925-8350
  • Fax: 914-925-8294
Mailing address:
  • Phone: 914-925-8350
  • Fax: 914-925-8294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number5954300N
License Number StateNY

VIII. Authorized Official

Name: MR. GOPAL P PATEL
Title or Position: CONTROLLER
Credential: CPA
Phone: 914-925-8208