Provider Demographics
NPI:1083754303
Name:LITTLE VILLAGE HOUSE, INC.
Entity Type:Organization
Organization Name:LITTLE VILLAGE HOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CARYL
Authorized Official - Middle Name:
Authorized Official - Last Name:BANK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-520-6003
Mailing Address - Street 1:750 HICKSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-1328
Mailing Address - Country:US
Mailing Address - Phone:516-520-6000
Mailing Address - Fax:516-520-6080
Practice Address - Street 1:150 PORT WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-1714
Practice Address - Country:US
Practice Address - Phone:516-365-4480
Practice Address - Fax:516-365-4438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01102809Medicaid