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General NPI Number Information
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NPI Number | 1699947374
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Entity Type | Organization
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Legal Business Name | PUERO RICAN FAMILY ICF # 3
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Dates
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Enumeration Date | 04/02/2008
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Last Update Date | 04/02/2008
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Provider Practice Location Address
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Address Line | 145 W 15TH ST FL 2
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City | NEW YORK
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State | NY
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Zip | 10011-6701
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Country | US
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Telephone | 212-414-7822
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Fax | 212-691-5635
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Provider Business Mailing Address
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Address Line | 194 W 180TH ST
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City | BRONX
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State | NY
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Zip | 10453-2905
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Country | US
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Telephone | 212-414-7822
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Fax | 212-691-5635
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Authorized Official
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Title or Position | CONTROLLER
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Name | KARL CINA
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Credential |
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Telephone | 212-229-6921
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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 | 06482441
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License Number State | NY
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