MEDICARE: UNITED ODD FELLOW AND REBEKAH HOME

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	251E00000X	Home Health Agency	7000611	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	:	1841474145
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNITED ODD FELLOW AND REBEKAH HOME

Provider Business Mailing Address
First Line	:	1040 HAVEMEYER AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-5382
Country	:	US
Telephone Number	:	718-863-6200
Fax Number	:	914-530-2177

Provider Business Practice Location Address
First Line	:	1040 HAVEMEYER AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-5382
Country	:	US
Telephone Number	:	718-863-6200
Fax Number	:	914-530-2177

Authorized Official
Title or Position	:	CEO
Name	:	MR. MICHAEL FELBERG
Credential	:
Telephone Number	:	718-863-6200

Provider Enumeration Date	:	12/21/2007
Last Update Date	:	04/10/2024

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