Provider Demographics
NPI:1083600969
Name:ST. JEROMES HEALTH SERVICES CORPORATION
Entity Type:Organization
Organization Name:ST. JEROMES HEALTH SERVICES CORPORATION
Other - Org Name:HOLY FAMILY HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:DENIS-SCHIANO
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:718-232-3666
Mailing Address - Street 1:1740 84TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-2825
Mailing Address - Country:US
Mailing Address - Phone:718-232-3666
Mailing Address - Fax:718-259-9180
Practice Address - Street 1:1740 84TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-2825
Practice Address - Country:US
Practice Address - Phone:718-232-3666
Practice Address - Fax:718-259-9180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01113226Medicaid
NY017335OtherEMPIRE BC & BS
NY=========OtherGHI
NY01113226Medicaid
NY=========OtherGHI
NY01113226Medicaid