Provider Demographics
NPI:1104041029
Name:NEW BROADVIEW MANOR HFA, LLC
Entity Type:Organization
Organization Name:NEW BROADVIEW MANOR HFA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LUDOVIC
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCOVICI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-273-8900
Mailing Address - Street 1:70 FATHER CAPODANNO BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-4803
Mailing Address - Country:US
Mailing Address - Phone:718-273-8900
Mailing Address - Fax:718-720-2415
Practice Address - Street 1:70 FATHER CAPODANNO BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-4803
Practice Address - Country:US
Practice Address - Phone:718-273-8900
Practice Address - Fax:718-720-2415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY610 F 062310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02375253Medicaid