MEDICARE: CATHOLIC MANAGED LONG TERM CARE INC

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	261Q00000X	Clinic/Center		NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619109089
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CATHOLIC MANAGED LONG TERM CARE INC

Provider Business Mailing Address
First Line	:	1432 FIFTH AVENUE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10026
Country	:	US
Telephone Number	:	212-752-2404
Fax Number	:

Provider Business Practice Location Address
First Line	:	1432 FIFTH AVENUE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10026
Country	:	US
Telephone Number	:	212-752-2404
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MAURA J SWEENEY
Credential	:
Telephone Number	:	212-752-2404

Provider Enumeration Date	:	08/18/2009
Last Update Date	:	08/18/2009

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