Healthcare Provider Details

I. General information

NPI: 1023097698
Provider Name (Legal Business Name): CARMEL RICHMOND NURSING HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 12/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 OLD TOWN ROAD
STATEN ISLAND NY
10304
US

IV. Provider business mailing address

88 OLD TOWN RD
STATEN ISLAND NY
10304-4212
US

V. Phone/Fax

Practice location:
  • Phone: 718-668-8500
  • Fax: 718-987-5228
Mailing address:
  • Phone: 646-633-4774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number7004310N
License Number StateNY

VIII. Authorized Official

Name: ANNMARIE COVONE
Title or Position: SRVP CFO
Credential:
Phone: 646-633-4702