Provider Demographics
NPI:1013383264
Name:ST. MARY'S HOSPITAL FOR CHILDREN
Entity Type:Organization
Organization Name:ST. MARY'S HOSPITAL FOR CHILDREN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:MS
Authorized Official - First Name:LUCINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTHEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-819-2882
Mailing Address - Street 1:507 BAINBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11233-2002
Mailing Address - Country:US
Mailing Address - Phone:718-753-4431
Mailing Address - Fax:718-280-5804
Practice Address - Street 1:507 BAINBRIDGE ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11233-2002
Practice Address - Country:US
Practice Address - Phone:718-753-4431
Practice Address - Fax:718-280-5804
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY CARE PROFESSIONALS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY287016-13140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric