=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104956754
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNITED STATES CATHOLIC CONFERENCE ST. CABRINI HOME, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2007
-----------------------------------------------------
Last Update Date | 07/14/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CABRINI HOME, INC. 2085 RT 9W
-----------------------------------------------------
City | WEST PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12493
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-384-6500
-----------------------------------------------------
Fax | 845-384-6001
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | CABRINI HOME, INC. 2085 RT 9W
-----------------------------------------------------
City | WEST PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12493
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-384-6500
-----------------------------------------------------
Fax | 845-384-6001
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ACCTS RECEIVABLES
-----------------------------------------------------
Name | LIA BROGNANO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 845-383-3913
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | 012789
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------