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General NPI Number Information
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NPI Number | 1033611736
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Entity Type | Organization
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Legal Business Name | THE W GROUP AT NEW BROADVIEW, LLC
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Dates
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Enumeration Date | 03/08/2018
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Last Update Date | 10/15/2020
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Provider Practice Location Address
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Address Line | 70 FATHER CAPODANNO BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10305-4803
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Country | US
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Telephone | 718-840-3355
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Fax | 347-436-8045
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Provider Business Mailing Address
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Address Line | 2357 60TH ST
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City | BROOKLYN
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State | NY
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Zip | 11204-2689
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Country | US
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Telephone | 718-840-3355
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Fax | 347-436-8045
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Authorized Official
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Title or Position | PROJECT MANAGER
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Name | MRS. JENNIFER GRAJALES
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Credential |
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Telephone | 718-840-3355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 610-F-067
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 2670L001
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 610-F-067
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License Number State | NY
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