Provider Demographics
NPI:1093105835
Name:BROOKLYN UNITED METHODIST CHURCH HOME - ADHC
Entity Type:Organization
Organization Name:BROOKLYN UNITED METHODIST CHURCH HOME - ADHC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:D
Authorized Official - Last Name:PITTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-827-4500
Mailing Address - Street 1:1485 DUMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-4705
Mailing Address - Country:US
Mailing Address - Phone:718-827-4500
Mailing Address - Fax:718-827-7719
Practice Address - Street 1:1485 DUMONT AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-4705
Practice Address - Country:US
Practice Address - Phone:718-827-4500
Practice Address - Fax:718-827-7719
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BROOKLYN UNITED METHODIST CHURCH HOME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7001308N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02324225Medicaid