Provider Demographics
NPI:1033355219
Name:COBBLE HILL HEALTH CENTER INC.
Entity Type:Organization
Organization Name:COBBLE HILL HEALTH CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR LTHHCP
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALLA
Authorized Official - Middle Name:
Authorized Official - Last Name:IMAS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:718-237-1717
Mailing Address - Street 1:380 HENRY ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-6048
Mailing Address - Country:US
Mailing Address - Phone:718-237-1717
Mailing Address - Fax:718-834-2984
Practice Address - Street 1:380 HENRY ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-6048
Practice Address - Country:US
Practice Address - Phone:718-237-1717
Practice Address - Fax:718-834-2984
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COBBLE HILL HEALTH CENTER INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-18
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7001913L251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02918596Medicaid
NY337428Medicare Oscar/Certification