Healthcare Provider Details

I. General information

NPI: 1962563353
Provider Name (Legal Business Name): YONKERS RESIDENTIAL CENTER,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 S BROADWAY 1ST FLOOR
YONKERS NY
10705-2008
US

IV. Provider business mailing address

317 S BROADWAY 1ST FLOOR
YONKERS NY
10705-2008
US

V. Phone/Fax

Practice location:
  • Phone: 914-476-6502
  • Fax: 914-476-2421
Mailing address:
  • Phone: 914-476-6502
  • Fax: 914-476-2421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNY

VIII. Authorized Official

Name: MR. ROBERT CORKE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 914-476-6502