MEDICARE: JUDITH LYNN HOME FOR ADULTS, LLC

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
1	310400000X	Assisted Living Facility	020-F-817	NY

General Provider Information

NPI Number	:	1467722017
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUDITH LYNN HOME FOR ADULTS, LLC

Provider Business Mailing Address
First Line	:	1800 WARING AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10469-6331
Country	:	US
Telephone Number	:	718-379-4400
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 WARING AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10469-6331
Country	:	US
Telephone Number	:	718-379-4400
Fax Number	:

Authorized Official
Title or Position	:	CFO, MANAGER
Name	:	MR. RAPHAEL WEISS
Credential	:
Telephone Number	:	516-334-3838

Provider Enumeration Date	:	01/12/2012
Last Update Date	:	01/12/2012

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