Provider Demographics
NPI:1063866465
Name:CATHOLIC GUARDIAN SERVICES
Entity Type:Organization
Organization Name:CATHOLIC GUARDIAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FISCAL ACCOUNTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:ALBINO
Authorized Official - Last Name:ESPINO
Authorized Official - Suffix:
Authorized Official - Credentials:ACCOUNTANT
Authorized Official - Phone:212-371-1000
Mailing Address - Street 1:1011 1ST AVE
Mailing Address - Street 2:10TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4112
Mailing Address - Country:US
Mailing Address - Phone:212-371-1000
Mailing Address - Fax:212-371-1512
Practice Address - Street 1:909 MELVILLE ESTATES CT
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-2827
Practice Address - Country:US
Practice Address - Phone:212-371-1011
Practice Address - Fax:212-371-1512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7145201315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7145201Medicaid