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NPI Code Detail

MEDICARE: PROVIDENCE REST

MEDICARE: PROVIDENCE REST
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1385H00000XRespite Care7000306NNY
2314000000XSkilled Nursing Facility7000306NNY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11216OTHERNYFACILITY
2007381OTHERNYBLUE CROSS/ BLUE SHIELD
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063411262
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROVIDENCE REST
Provider Business Mailing Address
First Line : 3304 WATERBURY AVE
Second Line :
City : BRONX
State : NY
Zip : 10465-1554
Country : US
Telephone Number : 718-931-3000
Fax Number : 718-514-8447
Provider Business Practice Location Address
First Line : 3304 WATERBURY AVE
Second Line :
City : BRONX
State : NY
Zip : 10465-1554
Country : US
Telephone Number : 718-931-3000
Fax Number : 718-514-8447
Authorized Official
Title or Position : ADMINISTRATOR
Name : MS. SUSAN M STEINBERG
Credential : LNHA
Telephone Number : 718-931-3000
Provider Enumeration Date : 07/19/2005
Last Update Date : 07/08/2015

Similar Medicare Providers

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Practice Location Address:
3304 WATERBURY AVE
BRONX, NY
10465-1554
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1871754861 — PROVIDENCE REST OUTPATIENT REHABILITATION
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3304 WATERBURY AVE
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1689817157 — MICHELLE CHERRY TOLENTINO
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1679855241 — JANE DEMONTEVERDE
Practice Location Address:
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BRONX, NY
10465-1554
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1588106645 — STANLEY JEAN
Practice Location Address:
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Practice Fax:
1477105724 — ADRIANNA NICOLE MANZELLA
Practice Location Address:
3304 WATERBURY AVE
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Directions to “PROVIDENCE REST ” Practice Location

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