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General NPI Number Information
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NPI Number | 1700032190
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Entity Type | Organization
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Legal Business Name | ROOSEVELT CHILDREN'S CENTER
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Dates
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Enumeration Date | 08/18/2008
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Last Update Date | 08/18/2008
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Provider Practice Location Address
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Address Line | 848 PEIRSON AVE
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City | NEWARK
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State | NY
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Zip | 14513-9762
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Country | US
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Telephone | 315-331-2086
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Fax |
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Provider Business Mailing Address
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Address Line | 848 PEIRSON AVE
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City | NEWARK
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State | NY
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Zip | 14513-9762
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Country | US
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Telephone | 315-331-2086
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF NURSING SERVICES
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Name | MRS. FONDA E BENNE
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Credential | RN
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Telephone | 315-331-5001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 476400
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License Number State | NY
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