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General NPI Number Information
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NPI Number | 1063866465
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Entity Type | Organization
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Legal Business Name | CATHOLIC GUARDIAN SERVICES
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Dates
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Enumeration Date | 04/21/2016
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Last Update Date | 04/21/2016
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Provider Practice Location Address
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Address Line | 909 MELVILLE ESTATES CT
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City | MELVILLE
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State | NY
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Zip | 11747-2827
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Country | US
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Telephone | 212-371-1011
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Fax | 212-371-1512
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Provider Business Mailing Address
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Address Line | 1011 1ST AVE 10TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10022-4112
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Country | US
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Telephone | 212-371-1000
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Fax | 212-371-1512
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Authorized Official
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Title or Position | FISCAL ACCOUNTANT
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Name | MR. MARIO ALBINO ESPINO
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Credential | ACCOUNTANT
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Telephone | 212-371-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | 7145201
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License Number State | NY
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