=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578712162
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 99 FORT WASHINGTON HOUSES SERVICES FOR THE ELDERY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/18/2008
-----------------------------------------------------
Last Update Date | 09/18/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 99 FORT WASHINGTON AVE
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10032-4655
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-927-5600
-----------------------------------------------------
Fax | 212-927-5612
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 99 FORT WASHINGTON AVENUE
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NEW YORK
-----------------------------------------------------
Zip | 10032
-----------------------------------------------------
Country | UM
-----------------------------------------------------
Telephone | 212-927-5600
-----------------------------------------------------
Fax | 212-927-5612
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MISS REBECCA CAREL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 212-927-5600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------