=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942370994
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE BAPTIST HOME OF BROOKLYN, NY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2006
-----------------------------------------------------
Last Update Date | 05/24/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 46 BROOKMEADE DR
-----------------------------------------------------
City | RHINEBECK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12572-2317
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-876-2071
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 46 BROOKMEADE DR
-----------------------------------------------------
City | RHINEBECK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12572-2317
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-876-2071
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO, LNHA
-----------------------------------------------------
Name | KAREN ZOBEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 845-876-2071
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 1327301N
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------