MEDICARE: CATH CHAR NGHBHD SVS CRIBBIN ICF

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	315P00000X	Intellectual Disabilities Intermediate Care Facility		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	:	1841333945
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CATH CHAR NGHBHD SVS CRIBBIN ICF

Provider Business Mailing Address
First Line	:	191 JORALEMON ST
Second Line	:	9TH FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11201-4306
Country	:	US
Telephone Number	:	718-722-6038
Fax Number	:	718-722-6219

Provider Business Practice Location Address
First Line	:	21820 104TH AVE
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11429-2051
Country	:	US
Telephone Number	:	718-776-4190
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE SECRETARY
Name	:	MS. DONNA CORRADO
Credential	:
Telephone Number	:	718-722-6123

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	07/09/2008

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