=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396743464
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VILLAGE CENTER FOR CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2005
-----------------------------------------------------
Last Update Date | 10/04/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 214 WEST HOUSTON ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-337-9407
-----------------------------------------------------
Fax | 212-255-9459
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 120 BROADWAY STE 2840
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10271-0009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-337-5816
-----------------------------------------------------
Fax | 212-337-5710
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | DEBRA TIRADO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 212-337-5710
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 7002335N
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------